Bridging the gap for transtibial prosthetic rehabilitation : analysis for the development of a pro bono application

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dc.contributor.advisorVisagie, Suronaen_ZA
dc.contributor.advisorPienaar, Elzbethen_ZA
dc.contributor.authorVan Vuuren, Susanna Catharinaen_ZA
dc.contributor.otherStellenbosch University. Faculty of Medicine and Health Sciences. Centre for Rehabilitation Studies.en_ZA
dc.date.accessioned2023-02-19T11:29:16Z
dc.date.accessioned2023-11-16T09:30:15Z
dc.date.available2023-02-19T11:29:16Z
dc.date.available2023-11-16T09:30:15Z
dc.date.issued2023-03
dc.descriptionThesis (MHumanRehabSt)--Stellenbosch University, 2023.en_ZA
dc.description.abstractENGLISH SUMMARY: Background: In South Africa, people with lower-limb amputations face challenges accessing rehabilitation services. The reasons for poor access to rehabilitation are multifaceted. In rural settings of South Africa, referral pathways and coordinated rehabilitation by a multidisciplinary team are rarely available. It is well known that prosthetic rehabilitation leads to improved outcomes. Currently, there are few evidence-based best practice protocols applied in transtibial prosthetic rehabilitation internationally. Mobile health technologies can reach underserved populations, improve clinical outcomes, promote attendance and adherence, and improve health-related quality of life. However, currently, only 1% of mobile health applications are grounded in scientific evidence and is evidence-based-driven. Aim: This study aimed to identify rehabilitation interventions that can inform a rehabilitation application for transtibial prosthetic users in South Africa. Study design: The study was executed in two distinct phases, namely a systematic literature review and a qualitative descriptive study. Methods: The objective of the systematic literature review was to evaluate current literature on transtibial prosthetic rehabilitation interventions globally. The literature review was executed according to the PRISMA 2020 statement. The literature search was conducted between May 2021 and February 2022 and explored rehabilitation interventions as part of transtibial prosthetic rehabilitation. Nine articles adhered to the inclusion criteria and were reviewed. The analytical studies were assessed using the Cochrane Collaboration Risk of Bias tool. The overall quality of evidence was assigned using the Cochrane Grading of Recommendations, Assessment, Development and Evaluations system. The literature probe conceptualised five themes for exercise interventions to be included in transtibial prosthetic rehabilitation. The objective of the descriptive qualitative design was to explore transtibial prosthetic users’ rehabilitation needs and experiences. In addition, it determined prosthetists’ and physiotherapists’ opinions on interventions that should be included in transtibial prosthetic rehabilitation in South Africa. Non-probability sampling techniques were used to select participants among each population group consisting of prosthetic users (n=8), prosthetists (n=8) and physiotherapists (n=10). Qualitative data were collected through telephonic interviews and were analysed using a content analysis approach. The findings from the two phases and four sources were triangulated to identify rehabilitation interventions to be included in a pro bono rehabilitation application. Findings: Through data triangulation, two main concepts were identified to be incorporated into an application. The first concept was exercise interventions that focus on balance and weight bearing, joint mobility, muscle strength and gait. The findings also suggest that a rehabilitation roadmap, patient education and peer support should be included in the application. Conclusion: It was recommended that exercise interventions should focus on balance, weight bearing, muscle strength, joint mobility and gait. Prosthetic users should be able to practise at home and must not require additional equipment to execute the exercises. It was concluded that additional factors should be included in the application. These factors include a rehabilitation roadmap, functional prosthetic rehabilitation, patient education and support as well as to incorporate a social platform into the application.en_ZA
dc.description.abstractAFRIKAANSE OPSOMMING: Agtergrond: Mense met onderledemaat-amputasies ervaar uitdagings rakende toegang tot rehabilitasiedienste in Suid-Afrika. Die redes vir beperkte toegang tot rehabilitasie is omvattend. In landelike omgewings van Suid-Afrika is verwysingsroetes en gekoordineerde rehabilitasie deur ʼn multidissiplinere span selde beskikbaar. Dit is welbekend dat prostetiese rehabilitasie tot verbeterde uitkomste lei. Daar is tans min bewysgebaseerde bestepraktyk-protokolle wat internasionaal in transtibiale prostetiese rehabilitasie toegepas word. Mobiele gesondheidstegnologiee het egter die potensiaal om onderbediende bevolkings te bereik, kliniese uitkomste te verbeter, bywoning en nakoming te bevorder en gesondheidsverwante lewensgehalte te verbeter. Slegs 1% van huidige mobiele gesondheidstoepassings is bewysgedrewe en op wetenskaplike bewyse gegrond. Doel: Die doel van hierdie studie was om rehabilitasie-intervensies te identifiseer wat by ʼn rehabilitasietoepassing vir transtibiale prostetiese gebruikers in Suid-Afrika ingesluit moet word. Studie-ontwerp: Die studie is in twee afsonderlike fases uitgevoer, naamlik ʼn stelselmatige literatuuroorsig en ʼn kwalitatiewe beskrywende studie. Metodes: Die doel van die stelselmatige literatuuroorsig was om huidige literatuur oor internasionale transtibiale prostetiese rehabilitasie-intervensies te ondersoek. Die literatuuroorsig is volgens die PRISMA 2020-verklaring uitgevoer. Die literatuursoektog is tussen Mei 2021 en Februarie 2022 gedoen en het rehabilitasie-intervensies as deel van transtibiale prostetiese rehabilitasie verken. Nege artikels het aan die insluitingskriteria voldoen en is by die studie ingesluit. Die analitiese studies is met behulp van die Cochrane Collaboration Risk of Bias-instrument geassesseer. Die algehele gehalte van bewyse is toegeken deur van die Cochrane Gradering van Aanbevelings, Assessering, Ontwikkeling en Evaluasies-stelsel gebruik te maak. Die literatuurondersoek het vyf temas vir oefenintervensies vir transtibiale prostetiese rehabilitasie gekonseptualiseer. Die doel van die kwalitatiewe beskrywende ontwerp was om transtibiale prostetiese gebruikers se behoeftes aan rehabilitasie asook hulle rehabilitasie-ervarings te verken. Terselfdertyd is prostetikusse en fisioterapeute se menings oor intervensies wat by transtibiale prostetiese rehabilitasie in Suid-Afrika ingesluit moet word, bepaal. Niewaarskynlikheidsteekproeftegnieke is gebruik om deelnemers uit elke bevolkingsgroep te kies. Die bevolking het dus bestaan uit prostetiese gebruikers (n=8), prostetikusse (n=8) en fisioterapeute (n=10). Kwalitatiewe data is met behulp van telefoniese onderhoude ingesamel. Data is met behulp van ʼn inhoudsontledingsbenadering ontleed. Die bevindinge van die twee fases en die vier bronne is getrianguleer om rehabilitasie-intervensies te identifiseer wat by ʼn pro bono-rehabilitasietoepassing ingesluit moet word. Bevindinge: Deur die triangulasie van die databronne is twee hoofkonsepte geidentifiseer wat by ʼn toepassing ingesluit moet word. Die eerste konsep was oefenintervensies wat op balans, gewig op die prostese, gewrigsmobiliteit, spierkrag en loopgang fokus. Die bevindinge het ook aangetoon dat ʼn rehabilitasiepadkaart, pasientopvoeding en portuurondersteuning by die toepassing ingesluit moet word. Aanbevelings: Die aanbeveling is dat ʼn toepassing kan help om die toegangshindernisse wat transtibiale prostetiese gebruikers ervaar, te verlig. Die toepassing moet saam met konvensionele rehabilitasie of as ʼn tuisgebaseerde rehabilitasieprogram gebruik word.af_ZA
dc.description.versionMasters
dc.format.extentxvi, 179 pages : illustrations, includes annexures
dc.identifier.urihttps://scholar.sun.ac.za/handle/10019.1/128717
dc.language.isoen_ZAen_ZA
dc.publisherStellenbosch : Stellenbosch University
dc.rights.holderStellenbosch University
dc.subject.lcshAmputation -- South Africaen_ZA
dc.subject.lcshMedical rehabilitation -- South Africaen_ZA
dc.subject.lcshPeople with disabilities -- Rehabilitation -- South Africaen_ZA
dc.subject.nameUCTD
dc.titleBridging the gap for transtibial prosthetic rehabilitation : analysis for the development of a pro bono applicationen_ZA
dc.typeThesisen_ZA
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