Occupational Therapy

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Acute care in occupational therapy a package of care and the essential therapeutic equipment needed.
(2017) Chetty, Angela.; Tsoka.Gwegwen, Joyce.
ABSTRACT Introduction: Occupational therapy, together other clinical services are required by government to describe and outline their services so that minimum standards can be set, to ensure that quality care is delivered to all who use the public health service in South Africa. In KZN, where this study is focused, the vast majority of health institutions deliver acute care services at either a district, regional or tertiary level. Aligning therapeutic services to appropriate clinical service at each level will have an impact on optimal health care. Aim: This study focused on developing a package of services for occupational therapy in acute care and outlining an essential therapeutic equipment list. Methodology: A mixed methods explorative sequential study with three phases was implemented. The first phase focused on a documentation audit to determine the context, background and any relevant information on the topic. Approximately 13 documents were selected to conduct a thematic analysis and extract pertinent information to answer the research question. The second phase consisted of implementing a survey in KZN with all eligible occupational therapists to determine their opinions on existing information and generate new ideas. This survey was constructed utilizing information from the document analysis. The final phase ensured that consensus was drawn on a package of occupational therapy services and equipment list by conducting a focus group utilizing the nominal group technique. Senior experienced occupational therapists that worked in acute care constituted the expert group. Results: The documentation audit yielded a rich description of information which set the background on the survey questionnaire. A 78 % response from the survey ensured that the senior experts on the nominal focus group were well informed xii when drawing consensus on a final package of occupational therapy in acute care and the essential therapeutic equipment and assessments needed. Conclusion: This study will provide therapists with a baseline standard of care for acute care hospitals and assist them with motivating for appropriate cost effective resources to deliver effective services in KZN.
Addressing spirituality in group therapy : a qualitative study at a shelter for abused and vulnerable Muslim women in Durban, South African.
(2016) Soomar, Nazeemah.; Crouch, Rosemary B.
Spirituality has gained recognition as a vital factor in mental healthcare, and has been applied to major occupational therapy models. However, its clinical application is limited universally, to the possible detriment of patients. This phenomenological study aimed to explore the experiences of abused and vulnerable Muslim women on addressing spirituality in occupational therapy groupwork, including understanding a definition of spirituality, and avenues to address spirituality. An inpatient Women's centre with a spiritual ethos was identified, where patients were exposed to a series of occupational therapy groups including concepts of spirituality. Semi-structured individual interviews were conducted on 7 purposively selected participants, and followed by thematic analysis. The findings reflected through the emergence of 4 themes that addressing spirituality conforms with client-centeredness, and enhanced a sense of meaning and purpose for the participants. Strength and motivation was drawn from applying spiritual concepts in group therapy sessions, ultimately facilitating better coping and empowerment, which reflected in their daily occupation. Implications of this study extend to curriculum development, treatment and service delivery, and health promotion.
Barriers to admission to mainstream primary schools for children with high functioning autism/asperger's syndrome (Umlazi District)
(2014) Collins, Carryn.; Pahl, Jennifer Ann.; Turnbull-Jackson, Carolyn.
In South Africa basic education is a right for all children (Constitution of the Republic of South Africa, 1996) and mainstream education for learners with so called mild disabilities such as High Functioning Autism or Asperger’s Syndrome (HFA / AS) is available according to government policy (White Paper 6, South African Department of Education, 2001b). The aim was to explore barriers to admission to mainstream primary school education for learners with HFA / AS. A mixed methods research design with two phases was used. Twenty-eight government primary schools in two circuits of a KZN school district completed a questionnaire; five parents of children with HFA / AS took part in a focus group discussion and an autoethnographic essay was written by the researcher. The data were analysed with descriptive statistics and thematic analysis. Some schools and the majority of parents were unaware of the learners’ educational rights. Gaps in the implementation of policy exist, which contributed significantly to the barriers to admission for learners with HFA / AS. Main barriers were lack of knowledge and misconceptions about HFA / AS amongst school staff, lack of training for school staff, lack of government funding, lack of unity between parents and teachers/schools and negative attitudes towards inclusion of learners with HFA / AS. Suggested ways of overcoming the barriers to admission included small classes, class assistants or facilitators, improved unity and communication between parents and teachers and greater government support. With solutions addressed in the future, learners with HFA / AS can access suitable education in order to become contributing adults to society (Attwood, 2007).
Client perceptions of social skills development occupational therapy intervention groups in an acute psychiatry setting.
(2017) Radnitz, Andrea.; Christopher, Chantal.
Pre-amble: This document is written in the format of a “Masters by manuscript”, as per the requirements of the University of KwaZulu-Natal’s research office. The transition away from “Masters by dissertation” has been made in 2017, by the University of KwaZulu-Natal, in order to encourage students to publish their work, thereby, making more of the research conducted for degree purposes accessible to the public, to aid in the transfer of knowledge. The university’s formatting requirements can be found under attachment A. The research articles have been referenced according to the guidelines of the journals to which they will be submitted. The rest of the document, for consistency, has been referenced according to the guidelines of the second journal article; an adapted Harvard referencing system. These guidelines can be found in Appendix J
“Consensus on an infant massage programme for high risk infants from resource constrained contexts: a Delphi Study with Physiotherapists and Occupational Therapists.”
(2017) Perks, Lauren.; Rencken, Gina.
The attachment of the mother to her infant is one which aims to provide the foundation for the infant’s well-being and adaptation (Bowlby, 1958; Carter, et al., 2005 in Atzil, Hendler, & Feldman, 2011 p.1). However, it is evident that primary caregivers present with difficulty with bonding and attachment with infants who were born in the high risk category as a result of delayed responses from the infant to the caregiver’s cues as well as from a variety of emotional reactions in the caregiver (McClure, 2000, p. 167). This alongside limited access to financial resources, limited transport and underresourced hospitals (Salojee, Rosenbaum, & Stewart, 2011, p. 37) contributes to making the attachment and bonding process difficult. This study aims to explore this dynamic and to develop an infant massage programme, through consensus from Occupational Therapists and Physiotherapists. As shown in literature this will assist this dyad in the attachment and bonding process amidst all the challenges and constraints which they are faced with.
Current trends in splinting the hand for children with neurological impairments.
(2015) Hepworth, Lauren Michelle.; Rencken, Gina.; Govender, Pragashnie.
Aim: The study aimed to explore the current splinting practises as used as a method of intervention for improving hand function in children with neurological impairments within the South African context. Methodology: A quantitative cross-sectional design using an electronic selfadministered questionnaire was utilised in order to address the objectives of this study. The sample included Occupational therapists working within the paediatric neurological field in South Africa. The study sample was collected through convenience and snowball sampling in order to target therapists specifically working in the area of paediatric neurology. Results and Discussion: Forty therapists completed the survey in its entirety. Therapists splint for various reasons and are in agreement that splints can be effective in neurological cases. The 3 most prevalent splints are the functional resting, thumb abductor and anti-spasticity splint with therapists mainly splinting to maintain or improve ROM. Conclusions: This study provides an insight into the splinting practices amongst occupational therapists who work with neurologically impaired children. It shows that therapists do choose to splint despite the controversy that surrounds splinting in neurology and that many factors are considered during the decision-making process.
The effectiveness of Transcutaneous Electrical Nerve Stimulation (TENS) versus Interferential Current (IFC) in the treatment of pain following a distal radius fracture.
(2015) Thaver, Seleena.; Maharaj, Sonill Sooknunan.
Purpose : The radius bone in the forearm of the human body, is an integral component of the wrist joint. Optimal wrist joint function plays an important role in maintaining dexterity of the upper limb. The inability to use the upper limb due to injury or pathology, impacts on activities of daily living, like personal care, occupational needs, and social activities. Following the fracture of the distal radius, a period of immobilisation is required for the injured structures to heal. Physiotherapy after the period of immobilisation is aimed at improving mobility, strength and flexibility of the affected joint. At this stage, patient’s main complaints are pain and stiffness which is impeding on functional use of the affected limb. Analgesia is usually prescribed to the patient for pain management, however in the South African public sector, drug shortages is a problem. Therefore there is a need to investigate a rehabilitation intervention that may reduce pain and hasten functional recovery after a distal radius fracture (DRF). Transcutaneous Electrical Nerve Stimulation (TENS) and Interferential Current (IFC) are two electrotherapy modalities, commonly used in the management of pain. Their effectiveness in reducing pain following a distal radius fracture has not been established. Therefore this study was designed to determine the effectiveness of TENS and IFC in reducing pain experienced following a distal radius fracture. Methods: The design of the study was a pre-test, post-test between subject study. Fifty four patients were randomly assigned to a TENS and exercise or IFC and exercise group. Both groups engaged in a 2-3 week programme, which comprised of six sessions of intervention. Pain was recorded with the Verbal Numerical Rating Scale (VNRS). Range of movement was measured with a goniometer and muscle strength with a modified sphygmomanometer. Functional ability was assessed with activities from the Patient Rated Wrist Evaluation (PRWE). Results : Statistical analysis was done with IBM SPSS (Version 21.0, IBM Corp., Armonk, NY). There was no significant differences between groups at the baseline with post 2-3 weeks showing compliance with TENS and exercises of 37% (n=20), IFC and exercises 37% (n=20). There were significant improvements (p < 0,05) in pain, range of movement, grip strength, and functional ability with both interventions. IFC was found to be significantly more effective in increasing wrist flexion and extension range of movements. Conclusion : Tens and IFC are effective in reducing pain following a distal radius fracture. There was no significant difference between the two modalities in reducing pain. Other variables of range of movement, muscle strength and functional ability also improved.
Electronic device use and fine motor dexterity and handwriting in grade 2 elementary school children.
(2015) Keller, Monique Marie.; Govender, Pragashnie.; McIntyre, June.
Aim: The study aimed to investigate whether a correlation exists in the electronic device usage and fine motor dexterity and handwriting in Grade 2 elementary male and female children. Methodology: A quantitative, correlation study design was utilized. Stratified sampling was employed to select n=34, grade 2 children together with their parents/primary caregivers. A parental self-administered questionnaire measured the electronic device type and frequency of use by the children. The children’s fine motor dexterity was measured with the Nine-Hole- Peg-Test and handwriting was measured with the Minnesota Handwriting Assessment. Data was analysed using SPSS version 22. Results and Discussion: Touch screen cellular phones and standard size tablet computers were most frequently used. The mean total time per week spent on electronic devices amounted to 9.3 hours and 5.5 hours per week across all mobile devices. Statistical significant correlations were measured for; total device use and total handwriting score (rho=0.110), total device use and non-dominant hand’s dexterity (rho=0.137), weak trunk stability and handwriting speed (p=0.007), male children’s handwriting speed was superior (p=0.015) and female children’s form of handwriting was superior (p=0.005), male children used handheld videogames more than female children (p=0.001). Conclusions: A weak positive correlation exists between the total time spent on electronic device usage in a week and non-dominant dexterity and handwriting. This implies that more frequent total electronic device usage per week has a higher handwriting total score but weaker non-dominant hand dexterity as a result. No correlation existed between total usage and dominant dexterity. Gender differentials revealed that males displayed faster and superior total scores in handwriting, females displayed superior scores for form, alignment and spacing and dominant/non-dominant hands’ dexterity.
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.
The experience of raising a child with down syndrome : perceptions of caregivers in KwaZulu-Natal.
(2013) Barr, Megan.; Naidoo, P.; Rencken, Gina.
Introduction: Due to limited research within KwaZulu-Natal there is a deficit in the knowledge base and understanding surrounding the dynamics of caring for a child diagnosed with Down syndrome. The study aims to inform health professionals who adopt a psychosocial approach, such as occupational therapist, in an effort to improve the therapy and handling of the caregivers and children. Methodology: A sequential explanatory mixed method approach with an interpretive phenomenological perspective was utilized. Sampling utilized non-probability methods from the Down syndrome Association (KwaZulu-Natal) database. An initial quantitative descriptive survey (n=57) guided the subsequent qualitative phase encompassing focus groups and interviews (n=18). Quantitative data was statistically analyzed using SPSS (version 21) and the transcribed quantitative data utilized thematic analysis with in vivo, emotions and descriptive coding. Results and Discussion: Experiences were primarily influenced by initial reactions of the participants; their level of knowledge of the syndrome and reactions to informing their family and community. Thereafter the positive and negative aspects of raising the child affected their perceptions. Conclusion: Many factors contributed to the participants‟ perceptions of raising a child with Down syndrome, namely: community and family attitudes; support structures available; positive factors such as personal growth as well as negative factors such as the erratic health of the child and difficulties with inter-personal relationships. However; an overall positive perception was reported by the participants, with an emphasis on advice to other caregivers based on lived experience.
An exploration of albino identity amongst groups of teenaged girls at a special school in KwaZulu-Natal, South African.
(2015) Vally, Farhana.; Lingah, Thanalutchmy.
A qualitative study probing Albino Identity amongst groups of teenaged girls at a special school in order to find out if a group identity based in Albinism exists. An exploratory research design allowed the researcher to explore the worldview from the participant's perspective. The method of investigation used three focus groups of four participants each to explore the psycho-social constructs that defined the shared reality of the participants as a group because of medical condition. Personal accounts from the participants facilitated the exploration of their perception through homogenous focus groups. This study had four objectives. The first objective was to examine how the social identity shapes the personal identity of the participants with Albinism. The second objective was to explore and identify common social experiences that the participants shared which have meaning for them in order to better understand their personal reality as a group. The third objective was to understand how social constructs contribute to defining the personal reality of the participants. The fourth objective of this study was to explore the psychosocial reality of Albino Identity as a shared group identity. The data yielded from the three focus groups was analysed using Thematic Analysis. Themes that emerged from the focus group were grouped into three broad heading namely Differentiation Based On a Lack Of Pigmentation, Treated Differently Because of Colour and Albinism Changes Social Interaction. The study's findings show that the social identity changes the personal identity in the same way. The participants share the same experiences with the social identity due to the lack of pigmentation. The participant's personal identity is altered through social interaction with the group mind. Social interaction with social constructs such as family and peers were more meaningful to the participants than with strangers. Albino Group Identity does exist and has value for the participants because it creates a sense of belonging and community for the participants outside of their family. Participants also reported being more comfortable around large numbers of Albinos because there is an absence of threat and hostility, giving the participants more security and acceptance. Members of the identity group based in Albinism regards the lack of pigmentation as a norm. This study has identified several group norms observed by its group members of Albino Group Identity. Safety concerns regarding the sun is a group norm along with dressing for the sun. Group members also reconstitute their behaviour to accommodate the social identity. The group strive for normality is the antithesis to the myths based in the collective unconscious. Albino Group Identity also demands the resolution of an identity crisis that is based in the colour that is created by Albinism. The findings of this study allows for practical adaptation of group therapy with learners with Albinism who present with maladaptive behaviour patterns. Future research in the area of group identity amongst persons with Albinism is recommended.
Exploring occupational therapy intervention for young children with autism spectrum disorder in South Africa.
(2013) Moosa, Aneesa Ismail.; Gurayah, Thavanesi.
Occupational Therapy is amongst the top three interventions sought for young children with ASD in South Africa. Due to scarce local research on OT for ASD, this study explored the nature as well as perceptions of OTs on intervention for ASD. Using a qualitative exploratory study design, semi-structured interviews were conducted with twenty OTs in public and private health, as well as special needs education. Thematic analysis was used to analyse transcribed data. OTs descriptions and perceptions of assessment, direct and indirect intervention as well as challenges facing families and undergraduate and qualified OTs in South Africa were explored. Assessment for ASD utilised play based skilled observations with limited use of standardised tests. Developmental approaches were preferred to behavioural ones, with the majority of OTs referencing the Sensory Integration (SI) framework for assessment and therapy, even if they were not SI certified practitioners. The value of SI in reframing a child’s behaviour for parents was significant. The South African Model of Creative Ability was a unique local application to practice for ASD. Intervention in education was most ASD specific, including AAC and visual approaches due to a comprehensive programme and greater levels of team collaboration. A family focussed practice was most evident in private and public health. Direct individual therapy was predominant, with all sectors struggling to provide the intensity of therapy recommended for ASD, due to unique contextual challenges. Undergraduate training is insufficient preparation for working with ASD and a need for local OT specialists was identified. Implications for research and practice are discussed.
Factors affecting attendance and participation in group therapy in a private inpatient psychiatric setting.
(2015) Clark, Vicky Lilian-Ann.; Lingah, Thanalutchmy.; Evans, Dylan Jiva.
This study seeks to understand why many patients did not participate in a group therapy programme offered at an inpatient psychiatric hospital in Pietermaritzburg, South Africa. Conducted by an Occupational Therapist, the study analyses a sample of inpatients’ perspectives, gathered via semi-structured interviews, of the factors that affect group therapy attendance and participation. The data was analysed qualitatively using thematic analysis. The results suggested that positive experiences and therapeutic outcomes, renewed hope and the helpful, supportive and non-judgemental nature of the group encouraged group therapy attendance and participation. These factors mirrored many of Yalom’s (2005) therapeutic factors. The following factors were found to hinder group therapy attendance: stigma, shame, a belief in the negative stereotypical portrayals of mental illness, physical pain, fatigue and negative side effects of medication. The findings were used to generate recommendations which could potentially be applied over a variety of clinical settings in order to increase group therapy attendance and participation and also enhance the therapeutic experience of the inpatient with a psychiatric illness.
The factors influencing the return to work of individuals having sustained severe traumatic brain injuries in South Africa.
(2016) Moller, Claire-Lynn.; Toerien, Leazanne.; Bainbridge, Jane.; Broughton, Shelly.; Jonck, Felicity.; Paruk, Rehana.
A traumatic brain injury (TBI) is a complex phenomenon where the ability to return to work (RTW) following injury is not always successful. Vocational rehabilitation (VR) is process that facilitates the RTW. Previous skills, habits and a familiar working environment need to be considered to ensure a successful client-centred intervention. The purpose of this study was to identify and explore factors influencing RTW of severe TBI’s who were employed in a stable, secure environment for more than three years prior to the injury. A qualitative approach was used to explore the lived experience of severe TBI’s. The aims and objectives were to identify and explore personal attributes, developed habits and routines, residual performance skills and environmental factors that enhanced or impeded the RTW of severe TBI’s. A semi-structured interview was guided by the worker role questionnaire and used as a gathering tool. The audio-taped interviews were transcribed and then thematically analysed using Braun and Clark’s six phase process. Two major themes emerged from the study namely; “It’s all about me” and The support for me”. The sub-themes from the first theme included my role as a worker, my abilities in the role and my emotions in the role. Sub-themes from the second theme included personal, work and rehabilitative support. The findings indicate that participating in work was of great importance to participants. Factors that enhanced the RTW were; developing and fulfilling the worker role, positive support, the ability to draw on past experience, knowledge and skills and VR intervention. Additionally, a previous stable and secure work environment emerged as a strong factor in enhancing RTW. Factors that impeded the RTW were a lack of support and uncertainty regarding residual abilities and the working environment. It highlighted that these factors were unique, inter-related and crucial in the fulfilment of self-worth. Although only two participants in this study received VR, there was strong emphasis on its impact on RTW and the need for this to be client-centred. This finding supports literature indicating VR in South Africa is limited. If readily available, it could have a positive effect on RTW of people with severe TBI’s.
The firework injured hand : profile and management.
(2014) Pilling, Tasha.; Naidoo, Pragashnie.
Aim: The study aimed to profile the firework injured hand and review of the management of such injuries from a surgical and rehabilitation perspective. Methodology: A quantitative methodological approach using a retrospective file audit was employed in order to address the objectives of the study. The study population was sampled from two identified provincial hospitals in the uMgungundlovu district and comprised of all patients who had sustained firework injuries from the 30th of December to the 5th of January during 2009-2014 (n = 65). Results were analysed using non-parametric statistics (viz. frequency counts and percentage matrices) through SPSS version 21 and Microsoft Excel 7. Results and Discussion: The analysis and discussion are organized across three content areas, namely, the profile of the firework injured hand, medical and surgical interventions and rehabilitative interventions. The results showed that the profile of the firework injured hand is varied depending on the blast capacity; however the thumb, index and middle fingers are predominantly affected at the level of the distal phalanges and distal interphalangeal joints resulting in amputation due to severe soft tissue injury and fractures. Hand Injury Severity Scores were completed retrospectively to ascertain the level of injury of which nearly half the cases surveyed fell within the severe category. Medical and surgical interventions were found to occur within the first three to six hours after injury and involved primarily washout, cleaning, debridement and suturing with formalization of amputation being the predominant course of action rather than reconstruction. Rehabilitation was focused on assessment and hand therapy to ensure functional outcomes. It was noted that there were inconsistencies in assessment procedures however the treatment modalities appeared consistent. Conclusions: On the basis of this study, it is recommended that the firework injured hand be treated according to the resulting diagnosis, that is, digital amputation, fracture, soft tissue injury and the coinciding symptoms of oedema, pain and stiffness which negatively impact on the outcome of hand function after this devastating injury. The limitations of the study are discussed and recommendations for future research in this field are offered.
The influence of an abductor pollicis longus strengthening program on the symptoms experienced by elderly females presenting with early stage osteoarthritis of the 1st carpo-metacarpal joint : a pilot study for an experimental pre-test/post-test design.
(2014) Simpson, Marti.; Chetty, Verusia.
Introduction: Elderly females are predominantly left impaired by the degenerative impact which osteoarthritis has on the 1st CMC joint. Research supports the successful implementation of early stage conservative management. Aim: To determine the viability of performing a full scale study to investigate the influence of an abductor pollicis longus strengthening program on the symptoms experienced by elderly females presenting with early stage osteoarthritis of the 1st CMC joint. Objectives: Validating data gathering instruments; evaluating methods and procedures used for recruiting, randomization; retaining, assessing and facilitating compliance of participants. Evaluation of the data capturing process. Required resources and sample size for a scientifically valid full scale study was estimated. Method: The pilot study made use of the quantitative research design proposed for a full scale study. Tools such as cost sheets and compliance logbooks were implemented along with qualitative components such as feedback questionnaires and field notes. Three retirement homes participated; 25 residents qualified to participate of which 15 were allocated to the experimental group and 10 to the control group. The experimental group participated in an 8 week exercise program; while the control group received an assistive device. Both the experimental and control groups were assessed at baseline; four weeks and after eight weeks. The assessment battery included the Kapandji index for thumb opposition, voluntary isometric total grip, 2-point pincer, 3-point pincer and key grasp strength, Visual Analogue Scale for pain and the Michigan Hand Outcome Questionnaire (MHQ). Data analysis: Data was captured by the researcher; the MHQ and feedback questionaires were independantly completed by the partiticpants. Data cleansing was conducted manually where corectness was verified by a third uninvolved party. Quantitative data was summarized and tested with the vi Generalized Estimating Equations (GEE) to detect possible changes over time. Inferential analysis and comparisons of results for the experimental and control groups could not be made. The researcher detected themes and subthemes within the qualitative data. Results/Discussion: Recruitment techniques’ response rate did not exceed 27%; qualitative data sets identified influencing factors An inclusion age of 60 years and older were suggested and to extend the research to various ethic groups. A large enough sample group for randomization was not obtained. Recommended adjustments to the assessment battery: using an adjusted MHQ as the full MHQ includes unapplicable questions; using a Numerical Rating Scale (NRS) for pain potentially being more user friendly for an elderly population; and an additional abduction active range of motion goniometer assessment for the thumb is recommended as the Kapandji scale for opposition provided limited information concerning the range of motion of the 1st CMC joint. The calculated cost per participant was R1921.60 for the control group and R3179.79 for the experimental group. Human resources were calculated at 64.2% of the entire budget. Compliance was affected by poor memory and health. Population attrition rates were calculated at an average of 48%. The feedback questionaires indentified personal gain and the feeling of contributing to a research initiative as the predominant themes for retaining the target population. Conclusion:The conducted pilot study can be used to define the parameters necessary to conduct then mentioned full scale research study, as well as assist with research designs envolving a similar target population. One more pilot study is recommended prior to a full scale study addressing topics such as including diverse races; recommended additional assessment tools and intervnetion components.
Integrating knowledge-to-practice for occupational therapists working with high-risk infants in the KwaZulu-Natal public health sector: a qualitative explorative inquiry.
(2020) Dawood, Ayesha.; Naidoo, Pragashnie.; Ogunlana, Michael Opeoluwa.; Rencken, Gina.
Introduction: Neonates are an at-risk population due to their increased susceptibility of mortality and morbidity. Occupational therapists have an important role in Early Childhood Intervention (ECI) and implementing Neurodevelopmental Supportive Care (NDSC) for high-risk infants whilst they are admitted in the Neonatal Intensive Care Unit (NICU). To the best knowledge of the author there is a paucity of literature available within the South African context in the use of evidence-based practices (EBP), and the integration of knowledge translation (KT) amongst occupational therapists who provide therapeutic management to high-risk infants and their families. Aim: This study aims to explore the knowledge to practice gaps experienced by occupational therapists who support high-risk infants in different levels of care in the public health sector of KwaZulu-Natal South Africa. Methods: A qualitative exploratory research design was used for this study. A nonprobability sampling technique was used. Seventeen occupational therapists who have more than two years of experience and are employed on a full-time basis in the public health sector of KZN participated in this study via online focus group discussions. Data were analysed using thematic analysis with inductive deductive reasoning, guided by a combined theoretical framework using the Appreciative Inquiry (AI) approach and KT process as a methodological orientation to the study. Research Ethics: Principles of confidentiality, autonomy, informed consent, beneficence, non-maleficence, and justice were adhered to. Participants were not of a vulnerable population and therefore support was not offered upon completion of the research discussions. Results: Five themes emerged in this study, namely, occupational therapy (OT) and neonatal care in the public health sector, Knowledge Acquisition and Knowledge Synthesis, Knowledge Translation/Utilization, Contextual barriers/adaptation, and the ideal OT in the ideal neonatal setting. Therapists outlined the facilitators, inhibitors, referral pathways and their personal interests in OT neonatal care. Supportive management and multidisciplinary teams (MDT) were highlighted as facilitators in the hospital environment whilst OT staff shortages, insufficient undergraduate training in the field and a lack of funding for courses for postgraduate OT training were regarded as inhibitors to practice. OTs source and synthesise knowledge from multiple sources to integrate, utilise and translate into neonatal practice. Contextual barriers are identified in various levelled facilities with acquired neonatal knowledge being adapted by therapists for low resourced settings. Participants envision the dream of the ideal day and therapist to intervene with neonates in the public health sector of KZN. Conclusion: Findings have identified several knowledge-to-practice gaps for OTs who support neonates in low resourced settings. Therapeutic resources and funding for postgraduate training, an improvement in the undergraduate curriculum, and policy development appear to be necessary to inform a standard of care across the province.
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.
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.
Long-term outpatient therapy: perspectives from acquired brain injury survivors, their caregivers and the therapy team: a KwaZulu-Natal study.
(2018) Reddy, Shivani.; Rambiritch, Virendra.
ABSTRACT Introduction: Acquired brain injuries often result in persistent residual impairments which negatively impact the individual for years after the injury, contributing to difficulty in the acquired brain injury survivor reintegrating into the community. A non-government organisation in KwaZulu-Natal provides long-term outpatient therapy to this population, with involvement from their caregivers, and the therapy team. This study aims to gain more insight into the stakeholders’ experiences of this type of the therapy, and whether there is a need for it. Aim: To explore the experiences and perceptions of acquired brain injury survivors, their caregivers and the therapy team involved in this long-term therapy programme. Methods: An exploratory, qualitative research design was used. The study was conducted at the non-government organisation providing long-term outpatient therapy for the acquired brain injury survivors in the province of KwaZulu-Natal, and the sample was recruited from participants attending this facility, using purposive sampling. Face-toface and telephonic interviews were conducted with participants who met the inclusion criteria, with a total of 11 participants recruited. Data was then analysed using thematic analysis. Results: Three main themes emerged, namely: the impact of an acquired brain injury indicating the need for long-term therapy; the benefits of long-term therapy for acquired brain injury survivors; and the challenges of long term therapy for acquired brain injury survivors. The acquired brain injury survivors still had residual deficits which impacted on their ability to engage in occupations, and as a result required continued intervention. Furthermore, participation in groups and long-term therapy reduced the participants’ feeling of social isolation and contributed toward the acquired brain injury survivors’ perceptions of being engaged in meaningful occupations. However, some changes to the programme were suggested. Conclusion: Acquired brain injury is a complex condition which can result in residual impairments, and which requires care on a long-term basis. The provision of long-term therapy for this population appears to have numerous benefits, and some challenges that need to be addressed. The provision of this service assists in bridging the gap between hospitalisation and community reintegration for the acquired brain injury survivors. Keywords: Acquired brain injury, ABI survivor, long-term therapy/rehabilitation, caregiver, therapy team.

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