3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item The assessment of health promoting lifestyle knowledge, stroke related risk factors and quality of life of stroke survivors in the Mofolo, Chiawelo, and Stretford communities of Gauteng, South Africa(2024) Sebulele, Tshepang ChriseldahIntroduction Factors that contribute to the risk of developing a stroke are largely modifiable such as eating a healthy diet, exercising, and having regular health screenings for early detection of disease. An understanding of the stroke survivor’s level of health promoting lifestyle knowledge, assessing their risk factors for stroke, and assessing their quality of life will shed light into understanding the factors contributing to the increased rates of stroke and developing appropriate health promotion programmes. Aim To determine clinical and demographic factors, the prevalence and knowledge of stroke risk factors and health promoting lifestyle amongst stroke survivors in the Mofolo, Chiawelo and Stretford communities of Gauteng and how these factors affect the quality of life of stroke survivors in those communities. Methodology Demographic and clinical information was collected using a questionnaire, prevalence of stroke risk factors was assessed using the stroke risk card, health promoting lifestyle was assessed using the Health Promoting Lifestyle Profile II, quality of life was assessed using the EuroQol-5 Dimension, and knowledge of stroke risk factors and warning signs was assessed using the assessment of stroke risk factors and warning signs of stroke survivor’s questionnaire. All data was collected at baseline and then again reassessed after three months. All data gathered were analysed using STATISTICA, categorical data from the demographic’s questionnaire were analysed using percentages and frequencies, continuous data from the stroke risk card, EuroQol-5 Dimension (EQ-5D), HPLPII and the stroke risk knowledge questionnaires was analysed using descriptive statistics calculating mean and standard deviation as well as median and Interquartile ranges. Results A total of 156 participants were assessed at baseline with only 49 (31%) returning for threemonths follow up. Hypertension was identified as the most prevalent risk factor for developing a stroke at baseline (65%) and at follow-up (73%). Eighty two percent had good health promoting lifestyle profiles at baseline and 78% at follow-up. Knowledge of stroke risk factors and warning signs was good (67%) at baseline and (53%) at follow-up. Sixty five percent of the participants were partially independent for mobility at baseline when compared to 73% at follow-up. Only 6% of participants rated their overall health as 100% at both baseline and follow-up. Conclusion Stroke survivors in the Chiawelo, Mofolo and Stretford communities of Gauteng are at an increased risk of stroke from clinical factors such as high prevalence of hypertension. Interestingly, stroke survivors in this study were shown to have good health promoting lifestyles and stroke risk factor knowledge. More research needs to be conducted in stroke survivors living in communities of similar profiles to understand the factors that increase their risk of stroke. Subsequently, the knowledge gained from further research can assist in the development of interventions such as continuous monitoring of stroke survivors blood pressure, cholesterol and blood glucose levels and creating health promotion campaigns specifically designed for stroke survivors to educate them on the lifestyle changes that assist to reduce the risk of stroke.Item A retrospective analysis of time delays in patients presenting with Cerebrovascular Accident (Stroke)(2017) Khalema, DitebohoRetrospective record review of time intervals regarding symptom onset, ED presentation and time to CT scan were recorded in patients who presented to the ED with signs and symptoms of stroke in 2014. RESULTS: There were 232 patient records included in the study. The average time to presentation to the ED was 33 hours with only 13.7% presenting within 3 hours. The earliest presentation was within 30 minutes of the onset of symptoms and the most delayed presentation was 3 months. Factors associated with early presentation were female sex, smoking and loss of consciousness. Known diabetic patients presented later than non-diabetic patients. Seventy-five percent of stroke patients had an ischaemic stroke and 25% were haemorrhagic. CONCLUSIONS: Due to delays in presentation, despite the availability of thrombolysis, patients are still not receiving thrombolytic treatment.Item Functional outcome at discharge from an acute inpatient hospital setting following first-time stroke(2018) Solomon, ThameenahBackground: Stroke is a common cause of prolonged disability and often patients are discharged early from hospital without achieving functional independence. Known factors that influence functional outcome following stroke are, amongst others, stroke severity, age and gender. Aim: To determine the functional outcome in ADLs and mobility of first-time stroke survivors upon discharge from an acute in-patient hospital setting. The objectives were a) to determine the ADL and mobility functional outcome at discharge of patients from an acute inpatient hospital setting following first-time stroke and b) to determine the factors that influence ADLs and mobility functional outcome at discharge from the acute inpatient hospital setting in patients following first-time stroke. Method: This study was observational, descriptive and cross-sectional. Consecutively admitted, medically stable, first-time stroke survivors admitted to an acute care hospital and who were referred for rehabilitation during hospital stay were screened for eligibility. Participants underwent two assessments upon discharge: the Barthel Index (ADL) and Modified Rivermead Mobility Index (MRMI). Continuous data were summarised as median, IQR, means and standard deviations, minimum and maximum scores. Relationship tests were performed between outcome scores and independent variables. Univariate linear regression was performed between dependent and independent variables. Those with an independent relationship with outcome scores were placed in a multivariate stepwise regression to determine predictive factors of functional outcome in the setting. Results: Sixty participants (35 Male and 25 female) were recruited. The mean age was 47.5 ± 12.14 and majority of the participants n= 52 (87%) had ischaemic strokes, moderate stroke severity (8.68 ± 4.48) and 20.6 ± 12.19 days length of hospital stay. Rehabilitation was initiated within one week of stroke (4.6 days ± 3.37) and total rehabilitation per day was 25.65 ± 15.07 minutes. Mean functional scores were 75/100 (BI) with self-care tasks most affected and 32/40 (MRMI) with mobility (walking) and stair-climbing most affected. Stroke severity was the single influencing factor found to influence both ADLs and mobility outcomes in this setting. The correlation between stroke severity and ADLs was moderate, negative and significant with r = -0.57 and p = 0.00. The correlation between stroke severity and mobility was moderate, negative and significant with r= -0.52 and p= 0.00. Conclusion: Functional independence was achieved in some ADLs and mobility items at discharge. Majority of the sample required additional rehabilitation. Stroke severity was the single factor found to influence functional outcome in both ADLs and mobility at discharge.Item Carotid intima media thickness versus plaque score: associations with stroke(2017) Gazwa, Pitchou ZongaIschemic stroke caused by large artety occlusions for most cases of stroke. The majority of cases of ischemic stroke occurs as a consequence of thrombus formation, following rupture, erosion or calcification of atherosclerotic plaque. Conventional cardiovascular risk factors such as hypertension, diabetes mellitus, smoking, and dyslipidemia account for the large burden of stroke in South Africa.Item The effectiveness of lycra compression garments on the upper limb in patients with stroke(2017) Naubereit, CareneIntroduction: Lycra compression garments have been documented as beneficial in affecting spasticity in children with cerebral palsy but there is little research on the use of Lycra compression garments in adults with neurological conditions. Thus, the purpose of this study was to explore the effectiveness of Lycra compression garments on motor function and functional use of the upper limb, in patients with stroke. Methods: A randomised control design with a control or intervention group was used. Both groups received routine upper limb rehabilitation while the experimental group also received a custom Lycra compression garment worn for a minimum of six hours a day. Results: Change between an initial assessment and assessment at six weeks, was measured on the Fugl-Meyer Assessment of Motor Recovery (FMA) and The Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH). While both groups had significant improvement in upper limb movement, statistically significant differences for change in total motor function, wrist and hand movement and coordination were found when the experimental group and the control group were compared. Small differences in measurements of pain, passive range of motion, sensation and functional use of the upper limb were found between the two groups. Conclusion: Results indicate that Lycra compression garments may be beneficial in facilitating the return of movement in the upper limb in individuals with stroke.Item The use of standardized assessments by occupational therapists in the management of the upper extremity after stroke in South Africa(2016) Phieros, DespinaOccupational therapists worldwide are under pressure to provide evidence for the effectiveness of their intervention in managing stroke; with South African therapists facing additional challenges. In managing stroke, one of the most significant aspects the occupational therapists must focus on is the effects of the lesion on the upper extremity and how this has an influence on participation in occupations. The use of standardized upper extremity assessments can provide objective information and can guide the most effective intervention. The extent to which these are used in stroke rehabilitation in South Africa has not been explored until now. The results of this study depict how occupational therapists working in the neurological field are not making use of the available standardized upper extremity assessments. Their described barriers or limitations include: lack of time, resources and familiarity. There is a need for improved education and training regarding all aspects of standardized upper extremity assessments. Occupational therapists in all settings must start using standardized upper extremity assessments in practice to ensure they are joining the evidence based practice movement.Item Content validity of the modified barthel index for stroke patients in South Africa(2016-10-12) Breytenbach, FionaBackground: The Barthel Index is considered the global golden standard for assessing of one’s performance in self-care tasks, but little research has been performed on the integrity of this outcome measure for the South African stroke population. Aim: The study aimed to determine whether the content validity of the Modified Barthel Index is adequate in assessing the ADL functioning of stroke patients in South Africa. Research design: Mixed methods design using the nominal group technique Methods: Four nominal group technique groups were held consisting of three to six participants per group. The study sample consisted of occupational therapists (n=11) and physiotherapists (n=4) with four or more years working experience (mean=13.7 years) in the field of adult neurorehabilitation in South Africa. Each group was presented with five questions based on the Table of Specifications methodology to analyse the content validity of the Modified Barthel Index. Data analysis followed Van Breda’s steps to analysing multi-group nominal group technique data to establish themes arising from each question and were presented according to final rank scores. Results: The themes receiving the highest rank score for each of the five questions concluded that the Modified Barthel Index should (i) be designed for use by therapists and nurses, (ii) remain in English, (iii) be re-worded to be clear and understandable, (iv) include all aspects of functional mobility, and (v) should accommodate for the effect accessibility barriers have on daily functioning. Conclusion: The Modified Barthel Index requires revision to improve its content validity for the South African stroke population. This study provides recommendations for the standardization of the tool.Item The effect of a written and pictorial home exercise prescription on adherence for people with stroke(2015-09-08) Kara, Sheetal RowjeeIntroduction: In South Africa the prevalence of patients with stroke that need help with at least one activity of daily living is equal to that of high income countries. Care of persons with stroke is essential, as stroke can lead to neurological deficits which in turn lead to functional impairments. Functional recovery for a patient, who has suffered a stroke, begins with rehabilitation. It has been found that supervised rehabilitation in an institution or at home improves the patient’s quality of life and fitness. It may not be feasible however, for the physiotherapist to supervise all rehabilitation, especially in a home-environment. Therefore adherence to exercise programmes is important. Adherence to exercise programmes allows for a potential saving in treatment costs, may avoid morbidity and unwanted side effects. The mode of exercise prescription may affect adherence to a home exercise programme. There are studies that show that the use of verbal prescription with an added brochure (a written and pictorial home-exercise programme) improves adherence rates. However none of these studies have been conducted in patients with stroke. Aim: The aim of this study was to determine the effect of a written and pictorial home exercise prescription on adherence with a home-exercise programme in patients with stroke at the Chris Hani Baragwanath Academic Hospital (CHBAH). Method: A randomised controlled trial with a blind assessor. Ethical clearance was applied for at the University of the Witwatersrand and permission to conduct the study was also obtained from CHBAH physiotherapy department and the superintendent before the commencement of the research project. Written informed consent was obtained from the patient and the caregiver before being included into the study. Participant’s anonymity was kept. All participants’ and their caregivers’ demographic data was captured on the initial assessment. The control group received a verbal home-exercise programme only and the experimental group received a verbal home-exercise programme with written and pictorial instructions for the exercises. An exercise logbook was completed by the participant’s caregivers to monitor adherence for each group. The Modified Rivermead Mobility Index (MRMI) and Barthel Index (BI) were used to establish mobility and activities of daily living functional ability of the patients. The significance of the study was set at 0.05. Between group comparison for the categorical data was carried out using the Chi square test. The Wilcoxon sign rank test was used for the between group comparison for the continuous data, the non-parametric data from the functional outcome measures as well as the adherence rates. Lastly the Spearman’s rank correlation co-efficient was conducted to assess if there is a relationship between the level of adherence and functional outcome in patients with stroke. Results: The average age of the participants was 60.8 (SD: 15.5) years. The gender distribution of the study population was 52% male and 48% female. Majority (76%) of the caregivers were females. Majority of the study population was living with a stroke for one to three months. The average length of stay in hospital was 14.5 (SD: 8.3) days. Of the study population 64% received in-patient physiotherapy. There was no significant difference between the intervention and control group for functional change and adherence: MRMI (p = 0.4), BI (p = 0.65) and adherence (p = 0.53). In the intervention group there was a greater increase in the MRMI score compared to the control group. But for the BI score the increase was greater in the control group. The relationship between functional ability (MRMI and BI) and the level of adherence for both the control and intervention group was generally not statistically significant. However, there was a weak relationship (p = 0.05, r = 0.44) for the intervention group for adherence and BI scores. Conclusion: The adherence rates were similar for the two groups despite the intervention that was administered. Both groups benefitted from the exercise therapy despite the mode of exercise prescription. Therefore there is no need to change the clinical practice at CHBAH regarding mode of home exercise prescription. Instead focus needs to be placed on interventions that can improve adherence to home exercise programmes e.g. the implementation of a monitoring system such as an exercise logbook.Item A study to determine which motor deficit has the strongest association with an improvement in functioning in activities of daily living in stroke patients(2015-09-07) Muller, CaitlinStudies to determine which underlying motor deficits have the greatest impact on improvement in functioning within activities of daily living in stroke patients are nonexistent with regard to the South African context. Effective stroke rehabilitation is essential due to rapid discharge rates and therefore it is important to focus on the motor deficit that will contribute most significantly to function. Patients from the ages of 35 to 85, who had suffered a stroke and were admitted to a private, neurological, rehabilitation facility in Johannesburg gave consent to participate in three outcome measures determining adequacy of balance (Berg Balance Scale), upper limb movement (Frenchay Arm Test) and gait (Timed Up-and-go Test) as well as one outcome measure determining level of functioning within activities of daily living (Functional Independence Measure). Results from the pre- and post-tests indicated that all participants improved during the time of rehabilitation. The findings of the outcome measures for each of the three different motor components were correlated with functioning in ADLs for each patient. The results showed that balance had the strongest correlation with functioning in ADLs, followed by upper limb movement, and then gait. The use of the FIM as a functional measure appeared to have some limitations and is not standardised to be used within the South African context.Item Convergent validity of the occupational therapy adult perceptual screening test with two other cognitive-perceptual tests in South Africa(2014) Razemba, FadzaiIn previous research done, convergent validity was not established for OT-APST with two cognitive-perceptual tests. In this research, the DLOTCA and RPAB were used as reference tools to determine the convergent validity of the OT-APST using Spearman’s correlation. The aim was to ascertain whether the three tests when administered at the same time would yield the same result. This was a quantitative cross-sectional study that was mainly correlative and comparative in nature. Convenience sampling was used (n=32). The tools compared evaluate similar constructs and were expected to have strong correlations. This current research revealed that six subscales of the OT-APST had significant correlations with similar cognitive areas from the DLOTCA and the OT-APST subscales often correlated with an appropriate item from the RPAB. This study provides sufficient evidence of the convergent validity of the OT-APST when compared to the DLOTCA and RPAB. The OT-APST proved useful in identifying patients with visual perceptual problems in a population not standardised for.