Browsing by Author "Rogers, Christine"

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    A review of childhood vestibular disorders
    (2010) Rogers, Christine
    Diagnosis of disorders of balance is challenging, as there are broad differentials and patients may present to a variety of healthcare practitioners, ranging from an audiologist to a psychiatrist. In addition, investigations, both at the bedside and laboratory, are often non-contributory, expensive and unpleasant. The adult dizzy patient is regarded with dread by many in the healthcare community: the patient is difficult to diagnose and challenging to treat, and the situation is frequently complicated by the presence of anxiety, panic and depression. When symptoms arise in childhood they cause alarm in the parents and the treating healthcare professional. Diagnosis and management of balance disorders in childhood, is even more demanding when patients are frequently unable to communicate the nature of the complaint. Furthermore, the aetiology and presentation of vestibular disturbance is markedly different between adults and children. Symptoms of vestibular disorders in children may easily be mistaken for behavioural or other medical problems, leading to under-diagnosis and inappropriate investigations and treatment. Detrimental effects of childhood vestibular disorders may include delayed gross motor development, learning and spatial problems, and time off school. This review summarises the most common causes of childhood vestibular disorders and suggests the need for a multidisciplinary approach to assessment.
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    A South African perspective: audiologists' and otologists' orientation to, and use of evidence-based practice with reference to benign paroxysmal positional vertigo
    (2021) Naidoo, Tanaya Ellen Ravi; Rogers, Christine
    Evidence-based practice, whose roots emanate from the mid-1960s, aims to provide fair, high-quality, and soundly researched health care with patients' best interests as a priority. Clinical practice guidelines are evidence-based and designed to assist clinicians with sound decision making. Despite the importance of evidence-based practice and the efforts invested into its development and dissemination, its uptake and implementation are poor. The disconnect between evidence-based practice and its translation into clinical practice was previously reported in low-to-middle income countries. This study investigated South African audiologists' and otorhinolaryngologists' (ear, nose and throat specialists') self-reported orientation to evidence-based practice. Second, adherence to evidence-based clinical practice guidelines was assessed with reference to the diagnosis and management of benign paroxysmal positional vertigo, a common vestibular condition for which a firm evidence base supporting treatment exists. A two-part quantitative approach was adopted. Part one surveyed South African audiologists and otorhinolaryngologists with the Evidence-Based Practice Profile Questionnaire and an additional researcher-developed questionnaire pertaining to the diagnosis and management of benign paroxysmal positional vertigo. A total of 130 survey responses were included in this study. Independent sample t-tests, one-way ANOVAs and Fisher's Exact tests were used to analyse the survey data. Part two used a retrospective record review at a tertiary academic hospital in the Western Cape of South Africa. Medical folders of patients diagnosed with benign paroxysmal positional vertigo, between 2010 – 2018 (n = 80), were analysed. The diagnosis and management strategies were recorded and compared against a gold standard evidence based guideline for congruence. Descriptive statistics were used to analyse and understand the data. Survey scores showed a positive association between increased years of experience and healthcare professionals' knowledge (p = .008) and confidence (p = .003) in evidence-based practice. Otorhinolaryngologists might be more knowledgeable than audiologists in evidence-based practice due to their increased training and exposure to evidence-based practice in their specialising years. Findings from the retrospective record review suggested adherence to the clinical practice guidelines in the diagnosis and management of posterior semi circular canal benign paroxysmal positional vertigo. The study outcomes propose that evidence-based clinical practice guidelines developed in the Global North may not be appropriate for the different health contexts that exist in low-to-middle income South Africa (e.g., rural settings). However, the benign paroxysmal positional vertigo clinical practice guidelines were adhered to at a tertiary, academic hospital in Cape Town. The results also support the notion that increased exposure to evidence-based practice reinforces its approach. Outcomes from this study raise implications for the development and dissemination of context-appropriate, evidence-based clinical practice guidelines.
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    Are we there yet? on a journey towards more contextually relevant resources in speech-language therapy and audiology
    (AOSIS Publishing, 2013) Pascoe, Michelle; Rogers, Christine; Norman, Vivienne
    Audiologists and speech-language therapists working in developing contexts like South Africa have the opportunity to address a range of needs through their research. One of these needs is the development of assessments and therapy materials that are appropriate for their clients’particular language needs and cultural background. This editorial paper aims to introduce original research in speech-language therapy and audiology, which has been carried out in South Africa and other developing contexts and is presented in this volume of the journal. In addition we suggest that while the focus of much research is on the destination or end product that is developed, there is a need to share the methodologies that are used to reach that goal so that more research can be carried out by a wider pool of students, researchers and clinicians. We describe some of the methods that we have used in our research – often in small scale projects with budgetary constraints, which would be feasible for clinicians in their routine clinical contexts. Our hope is that others can build on these approaches, critique and share their own strategies for the ultimate advancement of the professions in southern Africa.
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    Auditory characteristics and balance function of diabetic patients
    (2017) Hlayisi, Vera-Genevey; Ramma, Lebogang; Petersen, Lucretia; Rogers, Christine
    Aims and Objectives. This study aimed to describe auditory characteristics and balance function in patients with diabetes between 18-55 years of age as well as determine the association between patients' auditory and balance function with diabetes characteristics (type, duration and control). Background. Diabetes is one of the most prevalent non-communicable diseases worldwide with approximately 422 million people diagnosed globally. This number is projected to rise to 642 million by 2040 if no appropriate interventions are implemented to reverse the rise in the number of people with diabetes. South Africa has the second highest diabetes prevalence in Africa (after Nigeria) with 2.6 million cases. A rise in diabetes prevalence should be a concern for audiologists with increasing literature linking diabetes with the risk of acquiring hearing and balance disorders. However, there is currently a lack of research done in South Africa to investigate auditory and balance disorders in patients with diabetes. Therefore, the current study sought to investigate auditory characteristics and balance function in South African patients diagnosed with diabetes. It is anticipated that the study findings will yield evidence that will highlight the role of an audiologist in the clinical management of patients with diabetes. Research Design. The study utilised an observational cross-sectional matched groups design with a cohort (patients with diabetes) and control (volunteers without diabetes) group of participants. Participants were recruited from a Primary Health Care clinic in Polokwane, Limpopo using purposive and convenience sampling for the cohort and control group respectively. Methodology. Several methods were used to collect data pertinent to this study. These included case history interview and a medical folder review to obtain information related to participants' diabetes status. Furthermore, all participants underwent the following assessments: otoscopy, pure tone audiometry, diagnostic distortion product otoacoustic emissions (DPOAE), vision screening, peripheral neuropathy screening, Dynamic Gait Index test (DGI) and the Modified Clinical Test of Sensory Integration (MCTSIB). Data were analyzed using both descriptive and inferential statistical tests. Results. A total of 192 participants took part in this study; 110 in the cohort and 82 in the control group. There were similar distributions of gender in both groups with the following age distributions (in years) for each group; cohort; median =46, range =20-55, control; median =43, range =21-55. Pure tone audiometry assessments showed a significantly higher prevalence of hearing loss in the cohort (55%) when compared to the control (20%) group (p < .001). Participant age, gender and diabetes duration were associated with the likelihood of having hearing loss (age: odds ratio=2.90, 95% CI: 1.19-7.08, p=0.019; gender (male): odds ratio=.266, 95% CI: .104-.677, p=0.005; diabetes duration: odds ratio=1.12, 95% CI: 1.02-1.22, p=0.013). DPOAE assessments showed significantly higher percentages of abnormalities with signal to noise ratio (p < 0.01) and DPOAE level (p < 0.01) in the cohort compared to the control group. A significantly higher proportion (38%) of participants in the cohort group reported tinnitus when compared to 15% in the control (p < .001). Balance screening assessments with the DGI and the MCTSIB, showed significantly poorer performance in the cohort group than the control (DGI:, p < .001; MCTSIB: p < .001). Conclusion. Overall findings of this study showed that participants who were diagnosed with diabetes had a higher proportion of auditory and balance abnormalities when compared to those in the control group. Older age, male gender and longer duration since diabetes diagnosis were associated with a higher likelihood of having hearing loss. The findings of this study therefore suggest that auditory and balance dysfunction should be considered as comorbidities associated with diabetes. This study also highlighted the role of an audiologist in the managment of patients with diabetes with respect to early identification and management of auditory and balance dysfunctions amongst these patients.
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    Clinicians' knowledge, attitudes and behaviours towards evidence-based practice using clinical presentations of dizziness and vertigo as an exemplar
    (2022) Clarke, Richard Matthew; Rogers, Christine
    Evidence-based practice (EBP) is an approach to clinical decision-making that incorporates well-researched and established scientific knowledge with other sources of knowledge such as practitioner experience, patient preferences, and clinical context. Use of EBP aims to provide standardised care, which is rooted in the best available evidence. Among the most important and arguably clinically relevant outcomes of EBP are Clinical Practice Guidelines (CPG), which cover a variety of topics in medicine and associated professions. CPG exist for vestibular conditions, which are prevalent in the general and medical populations. Nevertheless, there is some suggestion that EBP regarding dizziness is sub-optimal in wealthy countries, and little is known about CPG use in LMIC, particularly across the professions that would be expected to use them. However, despite the availability and proliferation of evidence in the health sciences, research has shown that uptake and utilisation of EBP is poor even in the Global North. In low- and middle-income countries (LMIC) such as South Africa where resources are scarce, previous research has suggested that additional challenges exist which are specific to the developing context. There is, however, little research on translation of EBP into clinical practice. Thus, this study sought to investigate the knowledge, attitudes, and practices towards evidence-based practice of a specific subset of South African clinicians (audiologists, otorhinolaryngologists, and physiotherapists) in South Africa, using assessment and management of dizzy patients as an exemplar. Mixed methodology achieved the study's aims. Phase one employed a two-part questionnaire. Fifty-four participants, comprising 37 audiologists, five Ear, nose and throat surgeons (ENTs), and nine physiotherapists were surveyed to identify their orientation towards EBP using the Evidence-Based Practice Profile Questionnaire (EBP2Q). Independent samples t-tests and one-way ANOVAs were used to analyse the EBP2Q data. Three cases of common vestibular pathologies (Ménière's disease, vestibular migraine, and persistent postural perceptual dizziness) based on the CPG, were developed by the researcher and a Delphi panel of experts. Survey participants answered questions regarding implementation of CPGs in each case. Cases were scored according to matches with the CPGs. Phase two adopted a qualitative, descriptive approach and comprised four mini focus groups with a total of 10 participants representing the three professions surveyed. The focus groups aimed to explore participants' self-perceived barriers and facilitators to the use of EBP in general as well as in the context of dizzy patients. The most clinically relevant result was that the case questionnaire analysis revealed that approximately half of participants were able to identify Meniere's disease and vestibular migraine, whereas only one quarter of participants could identify the case of functional dizziness. Focus groups revealed barriers to the use of EBP such as lack of access to research and lack of time to research. Furthermore, participants recognised that the complexity of dizzy patients had led to sub-optimal assessment and management of such patients. Quantitative results of the current study suggested that participants with additional exposure to research through postgraduate training had higher scores on the EBP2Q in four out of five domains and the total questionnaire score than those with undergraduate training only. These results were consistent with previous research from wealthy countries which suggested that increased exposure through postgraduate training and working at academic facilities results in better orientation towards EBP. However, mean domain scores amongst participants in studies from wealthy countries appear to be higher than those from the sample on the current South African study, although it is difficult to tell whether the difference is statistically significant. Additionally, there was no apparent influence of years' experience on orientation towards EBP, contradicting what has been found in previous research. Outcomes of the study suggest that while healthcare practitioners have good attitudes towards EBP, it is more effectively implemented by clinicians with postgraduate training. Further, ease of access and exposure to research is the greatest facilitator to use of research and EBP by clinicians. Despite that, barriers to uptake and utilisation of EBP such as lack of access to research, lack of contextually relevant research, and low confidence at appraising literature were described. In addition, barriers common to the Global North and Global South were recognised such as lack of time to conduct literature searches and overburdening of clinical staff. Finally, a gap was noted in the knowledge of practitioners managing dizzy patients, specifically regarding patients with functional dizziness. Thus, this study highlights the need for use and application of EBP to the management of dizzy patients. Additional training of audiologists, ENTs and physiotherapists may be required regarding effective, multidisciplinary management of dizzy patients.
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    Factors contributing to falls in a tertiary acute care setting in Cape Town, South Africa: a descriptive study
    (2020) Irving, Athene; Rogers, Christine; Naidoo, Niri
    Introduction. Patient falls occur frequently in the acute hospital setting and are one of the most common adverse events experienced by hospitalised patients. In-hospital falls have negative outcomes for patients, causing injuries in up to half of those who fall. Falls in hospital create additional costs for health services due to increased length of stay (LOS), and greater health resource use. In contrast to much research focused on in-hospital falls worldwide, little is known about the rate, contributing factors and outcomes of inpatient falls in the state sector in South African hospitals. At the research hospital, a Falls Policy has been in place since 2013. The chosen falls risk screening tool, the Morse Falls Scale (MFS), had not been locally validated, and therefore its ability to accurately discriminate between patients who fall and patients who do not fall was unknown. A focused analysis of local falls incident reporting, and a description of contributory factors and consequences of falls, could better inform and target falls and fall injury prevention. Furthermore, this research may assist in service development and refining the Falls Policy. Methodology. The aim of this study was to obtain broad-based data on the magnitude of patient falls, and to identify factors contributing to falls. The aim was achieved in two parts, the first was a retrospective record review design. Predictive risk factors for falls were explored by comparing two patient groups, a Fall-Group and a Non-fall Group. In the FallGroup, further objectives related to describing circumstances surrounding fall events, including activities patients were performing at the time of the fall, the time of day and day of week the fall occurred, locations of fall events, and the clinical consequences sustained as a result of the fall. The use of the existing falls risk screening tool, the MFS, as well as its predictive accuracy to correctly identify patients at increased risk of falling was investigated. Second, a survey of nurses at the research hospital was undertaken to examine nurses' knowledge, attitudes and beliefs around the Falls Policy and current falls prevention practices. Results. There were 171 reported fall events during the ten-month period, representing 11.77% of adverse events and a falls rate of 0.73 per 1000 patient occupied bed days (POBD) during this time. Significant predictive risk factors for falling were a longer LOS and having a greater number of comorbid conditions. While the mean age of the sample was 50.0 years (SD=17.3 years), the Fall Group was significantly older than the Non-fall Group (p = .004). There were significantly more deaths in the Fall Group (p = .001), and this group had a longer average LOS (p < .001) compared to the Non-fall Group. The only sub-scale from the MFS that was significantly associated with falls was walking status. Minor-moderate clinical consequences were experienced as a result of the fall in 97% of cases (n=124). This study demonstrated that the MFS in use in the hospital has a low predictive accuracy of 55% at the current cut-off score of 50. At this score, the MFS has a sensitivity of 35.9% and a specificity of 75.4%. While an initial MFS was found in each of the cases, there was only evidence of a repeat MFS in 13 participants (9.7%) in the Fall Group. The nursing survey showed 70% of respondents had not had training on the Falls Policy (n=93) and only 37% (n=49) reported receiving regular feedback on fall rates. Receptiveness of most (66%, n=91) nurses to more training in falls prevention is encouraging. Discussion. The fall rate of 0.73 falls per POBD was lower than expected when compared to international studies. At the research hospital, when the Falls Policy was introduced in 2013, a fall was not defined in the policy and as highlighted in the nursing survey, there still appears to be lack of clarity on the fall definition. The MFS had a low predictive accuracy at the current cut-off score. The low sensitivity and specificity of the MFS in this setting may be due to the MFS not being updated regularly as per the Falls Policy. A further reason for the MFS poor predictive value may be the younger age group found in this sample when compared to international studies where the scale has performed better. Recommendations. The poor predictive value of the current risk screening tool found in this study is concerning. Therefore, further investigation into whether the MFS performs better if it is updated more frequently, and if completed in full, as per the Falls Policy, is recommended. Alternatively, the hospital should consider all patients with multiple comorbidities and those with longer length of stays at high risk, and provide interventions to minimise risk as per the Falls Policy. Future research into factors contributing to fall events and falls prevention should follow a prospective design and be supported at management as well as ward level. Further investigation into the most appropriate way to reduce harm from falls is recommended at the research site. Conclusion. This descriptive study provides a starting point for the hospital to examine the Falls Policy and falls prevention strategies currently in use. It is hoped that the study will contribute to local awareness-raising and capacity-building and help the hospital evaluate current practice and set a baseline for improvement.
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    Factors that influence the utilisation of ototoxicity monitoring services for patients on treatment for drug-resistant tuberculosis
    (2015) Nhokwara, Primrose Tinashe; Rogers, Christine; Ramma, Lebogang
    Multi-drug resistance is increasingly becoming a challenge to tuberculosis control programmes globally. Treatment of multi-drug resistance tuberculosis (MDR-TB) includes aminoglycoside antibiotics which are known to cause hearing loss. Ototoxicity monitoring services are often provided to patients undergoing treatment for MDR-TB for early detection of ototoxic hearing loss to facilitate alerting the patients and relevant medical staff about the presence and progression of any hearing loss. Previously, models of managing patients with MDR-TB required mandatory hospitalization for at least 6 months. This made it relatively easy to monitor the hearing status of patients during their stay in the hospital. However, with recent introduction of policy guidelines that support management of patients with MDR-TB on an outpatients basis, ototoxicity monitoring for these patients will need to be reorganized to align with the new policy guidelines. The extent of the uptake of these services when patients are accessing them as outpatients is however, unknown. This study therefore aimed to describe the patterns of utilisation and explore the barriers and factors that facilitate the use of ototoxicity monitoring services when provided on an outpatient basis in the Cape Town Metropolitan area, Western Cape, South Africa.
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    Influential factors in driving confidence among hearing-impaired older adults in Cape Town
    (2020) Cohen, Romy; Rogers, Christine; Chouhan Jay
    Research has shown that age-related hearing loss may have profound implications on all aspects of an individual's life, including cognitive abilities. The relationship between hearing loss and cognition has led to research which indicates an association between objective hearing loss and reduced driving performance in older adults. However, little research exists on the relationship between self-perceived hearing loss and driving confidence, particularly in the South African context. The current study aimed to identify possible associations between driving confidence and hearing loss, age, sex and driving safety among older adults. Data analysis indicated a significant increase in driving confidence after one month of first-time hearing aid use. An insignificant or weak relationship was found between self-perceived hearing loss and level of driving confidence. Age, sex and a combination of both were significantly associated with level of driving confidence. No association was found between pure-tone average and level of driving confidence or between pure-tone average and driving safety. Further research in this area could assist in advising legislation relating to licensing and road safety campaigns targeted at older adults, as well as expanding audiologists' duty of care to include counselling on the potential positive effects of hearing aid use on driving confidence.
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    Older Adults’ Experience of an Exergaming Intervention to Improve Balance and Prevent Falls: A Nested Explanatory Qualitative Study
    (2021-12-09) Rogers, Christine; Shamley, Delva; Amosun, Seyi
    Falls are frequent and life-changing events for older adults worldwide. The ageing phenomenon has arrived in developing countries, which experience tensions between curative and rehabilitative services, combined with an increase in non-communicable diseases. Policies addressing issues of ageing have been poorly implemented, and there are few fall prevention initiatives. Compelling evidence from the Global North supports exercise-based interventions to improve balance and reduce fall risk in older adults. More recently, attention has focused on interactive videogaming, known as exergames, as a novel way to manage fall risk with exercise. Commercially available exergames have inherent appeal for low- and middle-income country contexts, where rehabilitation professionals and resources are scanty. The aim of this study was to explore the feasibility of a large-scale randomized control trial comparing an exergaming intervention with the gold-standard Otago Exercise Programme and a no-intervention arm. Exercise adherence was poor in both intervention arms, and this prompted a shift to mixed methodology to explore the construct of falls and participants’ experience of the exergaming intervention. Focus groups were conducted, and the results were analysed using content analysis. Whereas the results demonstrated improvements in physical outcome measures (e.g., Timed-Up-and-Go, MiniBESTest) related to balance and falls that were encouraging in both the gold-standard and exergaming intervention groups, few participants achieved optimal adherence. Attitudes toward falls and fall prevention were explored, as well as participants’ experiences of the exergaming programme. Consistent with a developing country context, participants acknowledged both intrinsic and extrinsic fall risk factors. Exergaming participants enjoyed the fun and playful aspects of the exercise programme, yet these were not sufficient to maximize adherence. The focus groups described the barriers and facilitators to participation, which included motivation. The focus groups discussed strategies to enhance participation, and these are discussed in the context of exergaming.
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    Presbyastasis: a multifactorial cause of balance problems in the elderly
    (2010) Rogers, Christine
    Presbyastasis is the result of age-related physiological changes in the three sensory systems and their central connections that contribute to balance. In all likelihood, presbyastasis is a complex condition involving many intertwined systems rather than a lesion within the vestibular system only, thus evaluation and management need to be holistic. Balance problems can have detrimental consequences and are associated with falls, loss of quality of life and psychological sequelae such as anxiety, depression and panic. Healthcare practitioners need increased awareness of the pathophysiology of presbyastasis and its possible impact.
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    The presence and nature of dizziness in adults living with HIV attending HIV clinics in the Western Cape
    (2013) Chouhan, Jay; Rogers, Christine; Taljaard, Dunay
    Includes abstract. Includes bibliographical references.
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    The relationship between motor proficiency, bilateral vestibular hypofunction and dynamic visual acuity in children with congenital or early acquired sensorineural hearing loss
    (2010) Geldenhuys, Wilhelmien; Jelsma, Jennifer; Rogers, Christine
    The functional integrity of the vestibular system in children is not often tested. Due to the close relationship between the cochlea and the peripheral vestibular system, the function of the vestibular system may be impaired in children with sensorineural hearing loss.The aims of this study were to determine the prevalence of impairments of motor performance, vestibular function and dynamic visual acuity, and the nature and extent of interaction between these in children between the ages of four and fourteen years with congenital and early acquired sensorineural hearing loss. Motor performance was evaluated by means of the Movement Assessment Battery for Children-2, dynamic visual acuity was determined by means of the Dynamic Visual Acuity Test, and vestibular function with the Southern California Postrotary Nystagmus Test.
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    The feasibility and potential effectiveness of a conventional and exergame intervention to alter balance-related outcomes including fall risk: a mixed methods study
    (2020) Rogers, Christine; Amosun, Seyi Ladele; Shamley, Delva
    Introduction: Fall risk, occurrence and injury is increasing as the world ages, and Africa and other emerging regions will not be spared. Similarly, the rise of noncommunicable diseases, compressed morbidity and lack of physical activity present major challenges. This novel feasibility study explored the use of an exergaming technology compared with a conventional, evidence-based exercise programme (Otago Exercise Programme) to reduce fall risk by improving balance, and to inform a large-scale randomised control trial. Methodology: Mixed methods study in independent older adults with established fall risk. The quantitative component employed feasibility RCT methodology. Cluster randomisation assigned interventions to sites. Single blinding was used. Both interventions were offered for six months. A variety of balance-related endpoints (e.g., Timed Up and Go, Dynamic Gait Index, Mini-BESTest) were used to find the most applicable. Patient-centred variables included questionnaires regarding depression, physical activity levels, quality of life and estimates of self-efficacy for exercise. Qualitative focus groups explored participants' experiences of falls and the exergaming intervention using a phenomenology lens. Results: Site and participant recruitment was simple and readily achievable, with low numbers need to screen required. Eligibility criteria were confirmed and more added. Adherence and attrition were major challenges. Cluster randomisation appeared to exacerbate between-group differences at baseline. The exergaming intervention produced preliminary evidence in its favour, with results approaching Minimal Clinically Important Difference compared with the evidence-based intervention. The experience of the exergaming intervention was regarded as positive by focus group participants. Barriers and facilitators are reported. Discussion: Methodological issues in the literature have prevented firm consensus on the use of exergaming in falls prevention, although studies are abundant. The current study used rigorous methodology in the novel context of a developing region, which offers numerous challenges for older adults. Implications for a large-scale, fully funded RCT are discussed. Lessons learned can be used to scale up service delivery for an under-served population; and promote the aim of well-being for all at all ages.
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    Translation and Adaptation of the Self Assessment of Communication (SAC) and Significant Other Assessment of Communication (SOAC) into Afrikaans
    (2022) Liu, Chiawen Juoe; Petersen, Lucretia; Rogers, Christine
    Abstract The Self Assessment of Communication (SAC) and Significant Other Assessment of Communication (SOAC) are self-report outcome measures that are based on the World Health Organization's (WHO) International Classification of Functioning in Disability and Health (ICF) framework. The SAC and SOAC focus on hearing-related activity limitations, participation restrictions, quality of life, hearing aid use, and satisfaction from the perspective of the hearingimpaired individual and the communication partner or significant other (SO). The SAC is administered to the hearing-impaired individual, while the SOAC is the companion questionnaire that is administered to the SO. The SOAC focuses on the hearing disability and handicap of the hearing-impaired individual from the perspective of the SO. The SAC and SOAC were initially developed in English and standardised for a developed country population, the United States of America (USA). Thus, to make the outcome measures more relevant to a multicultural and multilingual country like South Africa (SA), the most practical solution is to translate and adapt the measure for the SA population. In SA, few audiological outcome measures have been translated and adapted. Therefore, to add value to the limited research available, the study aimed 1) to adapt and translate the SAC and SOAC into Afrikaans using the American Association of Orthopaedic Surgeons (AAOS) guidelines; and 2) to describe the usability of the Afrikaans SAC and SOAC by South African audiologists through surveys and verbal feedback interviews. The AAOS translation and adaptation guideline is a multi-step translation method that involves five stages: (i) Forward Translation from the source language (English) to the target language (Afrikaans); (ii) Synthesis of the forward translations; (iii) Backward Translation from the target language (Afrikaans) back to the source language (English); (iv) Expert Committee Review by analysing all the translations to create a pre-final Afrikaans SAC and SOAC measure; and (v) Field testing the pre-final Afrikaans SAC and SOAC. The field testing stage involved the target population (Afrikaans speaking hearing-impaired individuals and SOs) who analysed the pre-final Afrikaans SAC and SOAC. The participants in the field testing stage were sampled using purposive, convenience, and snowball sampling methods within the Western Cape Province in private practice. For the second aim of the study, 16 bilingual Afrikaans and English audiologists (referred to as audiologist participants) were sampled using purposive and snowball sampling. The audiologist participants were invited to use the Afrikaans SAC and SOAC in their practice for one to two months. Following implementation, the audiologist participants were required to comment on the usability of the Afrikaans SAC and SOAC by completing a survey. Three audiologists agreed to do a verbal feedback interview reporting their experience with the Afrikaans SAC and SOAC. Overall, audiologist participants' responses (survey and verbal feedback interview) indicated positive feedback regarding the translated Afrikaans SAC and SOAC. Most felt that the measure was a useful counselling tool, was user friendly and provides valuable information on the perception of hearing loss. However, some implementation challenges were reported such as (i) limited time available, which caused a delay in appointments with other patients, and (ii) patients' SO were not always present in consultation, as such, the SOAC could not be administered. In conclusion, findings revealed that following a multi-step approach when translating and adapting a measure is valuable, as it allows researchers to identify inaccuracies and discrepancies during the translation process to achieve a good quality translation. Furthermore, based on audiologists' perspectives, the Afrikaans SAC and SOAC can be used in clinical practice by South African audiologists. However, it is recommended that further research is necessary to explore psychometric properties such as criterion and concurrent validity.
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    The translation of the Vertigo Symptom Scale into Afrikaans: A pilot study
    (AOSIS Publishing, 2011) Rogers, Christine; de Wet, Jacques; Gina, Ayanda; Louw, Ladine; Makhoba, Musa; Tacon, Lee
    Vertigo is a common clinical problem that is challenging to diagnose and treat. While it has a broad range of aetiologies, the association between vestibular disturbance and anxiety is well established. The Vertigo Symptom Scale (VSS) is a questionnaire that assesses both dizziness and dizziness-related anxiety. The aim of this study was twofold. First, a translation of the VSS into Afrikaans was evaluated using the Delphi technique. Consensus was achieved within the Delphi rounds and a final tool was agreed upon. Second, the Afrikaans Vertigo Symptom Scales (AVSS) was piloted on a sample of vertiginous and control participants. The results of the pilot study yielded significant statistical differences between the groups on both subscales of the tool (vertigo symptom scale and anxiety and autonomic symptom scale). Results suggest that the AVSS is able to identify patients with vertiginous disturbance and anxiety. The AVSS presents with good sensitivity and specificity as measured by the ROC curve. Clinical implications are discussed.