Browsing by Author "Scott, Desiree"

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    Comparing outcomes of group and individualized physiotherapy treatment models for children with cerebral palsy in Ghana: a quasi-experimental study
    (2024) Banini, Sandra; Ntinga, Nomusa; Maart, Soraya; Scott, Desiree
    Background: Cerebral palsy (CP) is a global concern. The primary caregivers of children living with CP play a vital role in influencing the nature and direction of care the children receive. Physiotherapists are rehabilitation specialists who assist in efficient motor movement and quality of life in children with CP. Therefore, effective and appropriate physiotherapy treatment is essential to meeting the needs of both caregivers and children. The study compared the individual (IPTM) and group physiotherapy treatment models (GPTM) at two teaching hospitals in Ghana using the quasi-experimental design. Methods: Forty (n = 40) children with spastic cerebral palsy (SCP) took part in the study, along with their respective caregivers. Out of the total, 17 had IPTM, and at the same time, 23 had GPTM. Participating children preand post-measurements were recorded over a three-month treatment period, accessing their motor function (using the Gross Motor Functional Measure-88 (GMFM-88), Gross Motor Function Classification System Expanded & Revised version (GMFCS E&R) and Manual Ability Classification Scale (MACS)) and the caregivers' burden of care (MCSI), health-related quality of life (EQ5D 3L version of HRQoL) and satisfaction with physical therapy (MRPS). Results: Comparing outcomes between the IPTM and GTM at baseline showed no significant difference in the GMFM-88, GMFCS E&R, MACS, and VAS scores of the EQ5D 3L version of the HRQoL. However, there were significant differences between models for pre-MCSI and pre-MRPS results. There was no significant difference in intra-model comparisons of functional and caregiver outcomes, specifically, GMFCS E&R, MACS, and MCSI. However, the total dimension % of the GMFM-88 results showed a significant difference for IPTM (p = 0.004) and GPTM (p = 0.000). Similarly, there were significant differences for intra-model comparisons of VAS scores for the HRQoL (p = 0.016) and MPRS (p = 0.004) of caregivers from GPTM, whilst caregivers from IPTM had no significant difference in the VAS scores of the HRQoL (p = 0.097) and MRPS (p = 0.172). Results also showed that the GPTM had better attendance at physical therapy sessions than the IPTM.
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    Cross-sectional analysis of car restraint system use during transportation of children with special health care needs in the Western Cape
    (2020) Phillips, Kerry-Ann; Corten, Lieselotte; Scott, Desiree
    Background: Road traffic injuries are the leading cause of death in children and young adults. Children are at increased risk of fatalities and serious injury due to the differences in their body segment proportions affecting their body kinetics in a vehicle accident. Serious injury and death can be reduced by the appropriate use of car restraint systems (CRS). Children with special health care needs (CSHCN), particularly children with poor postural control, may need adaptive seating to improve postural support and sitting ability within the vehicle due to their additional physical needs. Standard CRS might be unsafe or inappropriate for children with physical disabilities. Research Aims: The thesis aimed to understand the current CRS usage as well as the parents' experiences and perspectives of transportation of CSHCN in the Western Cape, and to determine the postural support needs of CSHCN and the suitability of different CRS designs to meet these needs during transportation. This was achieved through a survey study, followed by a cross-sectional study. Assessing the use of car restraint systems in children with special health care needs; a Western Cape based survey study Objectives: To determine the modes of transport and the prevalence of the use of postural support systems by CSHCN. Along with describing the current use of seatbelts, standard or specialised CRS and exploring the challenges faced by parents of CSHCN during transportation. Methods: A descriptive quantitative survey was performed amongst a convenience sample of all parents of CSHCN between the age of 4 – 18 years enrolled at three special needs schools in the Western Cape, South Africa. Parents had to be able to read and understand English or Afrikaans to be eligible for enrolment in the study. Focus group discussions were conducted to validate the self-designed questionnaire. Results: Parents of 268 children were enrolled in the study (median (IQR) age 11.52 (14.63- 8.86) years; 58.96% male). The most common diagnosis was cerebral palsy (CP) (29.10%), and most children were transported to school with public transport, including school bus (73.13%). The mode of transport was linked to the distance travelled and affordability, and each had its own challenges. The main challenges of parents using private transport were transporting the wheelchair (10.82%) and the unavailability of demarcated disability parking bays (7.46%). When using public transport parents identified their child's poor sitting balance (6.34%) and lack of space within the vehicle (5.60%) as the greatest challenges. The majority of children (58.96%) came from low-to-middle income households (< R6500 per month), significantly impacting the use of a CRS, with more children from higher income families being transported in a CRS (X²= 48.14, p< 0.001). Difficulties with sitting balance was reported in 25.75% of the children and was significantly association to the parents understanding of their child's sitting balance (X²= 17.72, p< 0.001). Parents who felt that their child had difficulty with their sitting balance were more likely to use a CRS. Furthermore, a significant association between currently using a CRS and child's weight was observed (X²= 11.54, p=0.021), as children who weighed more were less likely to still be using a CRS. Most parents (54.48%, n=146) did not know South Africa's current legislation on CRS, which was significantly associated with a lower CRS usage (X²= 19.84, p< 0.001). Half of the parents (n= 139, 51.87%) were not willing to spend money on a CRS as they felt that a car seat was not necessary for their child. The amount parents were willing to spend on a CRS was significantly associated with having ever made use of a CRS (X2=43.38, p< 0.001). Conclusions: Parents of CSHCN reported many challenges in transporting their child depending on the mode of transportation. CRS usage was associated with parent perception on the child's sitting abilities, lower weight, knowledge of legislation and a higher household income. Despite these, CRS usage amongst CSHCN is lower than expected as (48.88% – 55.22%) children that are still within the age and weight range to use a CRS as required by law did not report CRS usage. This could link in with the affordability of the CRS and failure to know the legislation on CRS by parents. This study highlights the need for national campaigns to promote and educate citizens on road safety and CRS legislation. Due to the lack of financial resources in low to middle income countries, it is vital that an affordable CRS is made available or is subsidized by the government where families are unable to afford the cost themselves, particularly for use in public transport. Effectiveness of currently available car restraint systems to maintain correct seating position during transportation for children with special health care needs Objectives: To determine the characteristics of CSHCN who require specialised CRS for their postural support needs, through assessment of their sitting ability and whether these needs are met by different CRS. Methods: Participants in the earlier survey study were invited to take part in a crosssectional and pre-post design study. A screening tool for identifying sitting balance problems was developed and found to be reliable for inter- and intra-rater reliability (k>0.700, p0.879). This tool was used to identify CSHCN who had difficulty sitting independently on different types of seats. These participants underwent a standardised sitting balance assessment, using the Level of Sitting Scale (LSS), to identify eligible participants with postural support needs. Participants were excluded if they recently had surgery or had an unstable health condition which could alter their sitting balance. The ability of two standard CRS (Car Seat and Booster seat), two Specialised CRS (one locally and one internationally produced), and Seatbelt only to provide adequate postural support was investigated. Head and trunk postures were analysed and categorised, by deviation from the midline, by photographs taken from different viewpoints. Results: There were 78 CSHCN enrolled in the study (mean (SD) age 11.50 (3.70) years; 65.75% male), the most common diagnosis was CP (63.48%), the majority of participants did not require any support to maintain sitting balance and were categorised as levels 5-8 of the LSS (78.08%). According to the World Health Organisation anthropometric guidelines 54.79% (n=40) of the participants should still use a CRS, either a Booster Seat (42.47%, n=31) or a Car Seat (12.33%, n=9). The head or torso fully supported and between the side supports of the CRS was the most common posture in all the viewpoints of the different CRS except for the lateral head viewpoint of the CRS Car Seat (50.00%; n=4), the Booster Seat (60.00%; n=18), and the International Specialised CRS (60.61%; n=20), as well as the anterior torso viewpoint of the Seatbelt only (50.75%; n=34). The CRS that resulted in the largest proportion of unacceptable posture deviations from the standard position were the Seatbelt only (20.90%, n=56) and the Booster Seat (18.33%, n=22). Out of position (OOP) postures were observed in all the devices for the anterior and lateral head positions (3.03% - 20.00%). The Booster Seat, the Local Specialised CRS and the Seatbelt only devices had participants with OOP postures in all four viewpoints. A key observation in the current study is the lack of torso support for the majority of CSHCN in the anterior torso viewpoint of the Seatbelt Only CRS (55.22%, n=37), indicating that the use of a Seatbelt only does not provide adequate postural support for all CSHCN despite them meeting WHO anthropometric requirements. No significant association was found between the pre- and post-test postural analysis scores of the Seatbelt only (X2=2.14, p=0.144) which could be as a result of the large postural deviations pre-testing (41.79%, n=28) remained post-testing. However, there was a significant association between the preand post-test scores of the anterior head viewpoint of the Booster seat (X2= 7.94, p=0.005), indicating lateral head deviation. The post-test postural analysis score of the Booster Seat anterior head viewpoint was significantly associated with a deviated posture (X2= 7.94, p=0.005). Other OOP observations included postures that could not be categorised by head and trunk deviation from the midline including head or torso rotation, abnormal limb placement, body extension and slouching. Overall performance scores are a sum of the number of viewpoints where the CSHCN posture worsens post-test. an indication of the number of CSHCN whose posture worsened post-test in each of the viewpoints of the CRS. Although there was no correlation between the LSS score and the overall performance score of any CRS device which would indicate if the CSHCN balance influences CRS performance, the Booster Seat (80.00%, n=24) and the Seatbelt only (55.23%, n=37) devices had the greatest number of participants with a poor overall performance. The viewpoints which had the worst performance scores were the anterior and lateral head of the Booster Seat (46.67%, n=14 and 43.33%, n=13 respectively) and both viewpoints had majority of participants worsen their scores. All CRS performed adequately in the lateral torso viewpoint, indicating sufficient support of the torso in the sagittal plane. Conclusions: The postural support needs of CHSCN are unique and depend on the child's anthropometry and the severity of their disability. The currently available CRS designs may not provide the postural support needed for many CSHCN. Postural deviations of the head, torso and limbs were observed which could be dangerous in the event of an accident. This study was not able to determine specific characteristics of CSHCN that require specialised CRS, as there was no association between the LSS and the overall performance score for any of the CRS devices. However, devices that offer less head and torso lateral support, or do not offer additional harness support such as the Seatbelt Only and the Booster Seat showed the largest proportion of OOP postures in CSHCN. Thesis Conclusion: This thesis highlights the complex transportation needs of CSHCN in South Africa and how the different CRS can influence posture. Additional observational research is required to determine the CRS usage in the CSHCN population to compare to the prevalence of CRS usage found in this survey study. Future research could incorporate other specialised CRS designs, particularly ones that are suitable for CSHCN beyond standard CRS weight and height limits or those with severe physical limitations that could not be tested during this study's simulated course. Practitioners prescribing and advising parents on CRS devices for the safe transportation of CSHCN should integrate thorough patient assessment and knowledge of manufacturer CRS design specifications to promote CRS usage. Policies should consider and accommodate for the challenges faced by CSHCN and their families in accessing, affording and utilising transport services. Advocacy and education programs should be combined with legislation enforcement to support improved implementation of CRS usage amongst all children, regardless of their disability status. For effective implementation for CSHCN, CRS should be affordable, accessible, functional and accommodate growth and postural support needs.
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    Performance of the EQ-5D-Y Interviewer Administered Version in Young Children
    (Multidisciplinary Digital Publishing Institute, 2022-01-10) Amien, Razia; Scott, Desiree; Verstraete, Janine
    (1) Background: An estimated 78% of South African children aged 9–10 years have not mastered basic reading, therefore potentially excluding them from self-reporting on health-related outcome measures. Thus, the aim of this study was to compare the performance of the EQ-5D-Y-3L self-complete to the newly developed interviewer-administered version in children 8–10 years. (2) Methods: Children (n = 207) with chronic respiratory illnesses, functional disabilities, orthopaedic conditions and from the general population completed the EQ-5D-Y-3L self-complete and interviewer-administered versions, Moods and Feelings Questionnaire (MFQ) and Faces Pain Scale-Revised (FPS-R). A functional independence measure (WeeFIM) was completed by the researcher. (3) Results: The 8-year-olds had significantly higher missing responses (x2 = 14.23, p < 0.001) on the self-complete version. Known-group and concurrent validity were comparable across dimensions, utility and VAS scores for the two versions. The dimensions showed low to moderate convergent validity with similar items on the MFQ, FPS-R and WeeFIM with significantly higher correlations between the interviewer-administered dimensions of Mobility and WeeFIM mobility total (z = 1.91, p = 0.028) and Looking After Myself and WeeFIM self-care total (z = 3.24, p = 0.001). Children preferred the interviewer-administered version (60%) (x2 = 21.87, p < 0.001) with 22% of the reasons attributed to literacy level. (4) Conclusions: The EQ-5D-Y-3L interviewer-administered version is valid and reliable in children aged 8–10 years. The results were comparable to the self-complete version indicating that versions can be used interchangeably.
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    Performance of the EQ-5D-Y Interviewer Administered Version in young children
    (2022) Amien, Razia; Verstraete, Janine; Scott, Desiree
    Introduction The interest in Health-Related Quality of Life (HRQoL) in the paediatric population has grown over the last decade as it allows for a more holistic approach which has the potential to positively influence treatment outcomes (1–4). With an increase in interest, the need for alternative modes of administration of HRQoL instruments has become more important to allow for self-report in younger age-groups. Despite their age and/or literacy levels, their ability to understand the concept of HRQoL would allow for accurate self-report if the correct instrument is used (5). Proxy-report is used often as a default in these younger age-groups as only two interviewer-administered instruments are currently available (6,7), neither of which have been validated for African populations. The newly developed EQ-5D-Y-3L Interviewer Administered (IA) instrument would allow for self-report in younger paediatric populations, therefore limiting the reliance on proxy-report which does not account for the subjectivity of HRQoL or allow for the inclusion of the child's view (2,8–10). Aim The first aim of this study was to determine the performance and preference of the EQ-5D-Y-3L-IA and self-complete (SC), in children aged 8-10-years. The second aim was to determine the psychometric performance of the EQ-5D-Y-3L-IA version in children aged 5-7-years compared to those aged 8-10- years. Methods A cross-sectional, descriptive observational, analytical design was used. Children were recruited in two age-groups, 5-7-years (n=177, 46%) and 8-10-years (n=211, 54%). Participants were drawn from the General Population (GenPop) attending a Mainstream School (n=109, 28%), Special Schools for learners with special educational needs (n=55, 14%) and healthcare facilities caring for children with orthopaedic conditions (n=161, 41%) or chronic respiratory illnesses (n=63, 16%). All children completed the EQ-5D-Y-3L-IA, Faces Pain Scale-Revised (FPS-R), Moods and Feelings Questionnaire (MFQ). The researcher completed the observational Functional Independence Measure (WeeFIM). In addition, children in the 8-10-year group completed the EQ-5D-Y-3L-SC. Dimension responses of the EQ-5D-Y-3L-IA and SC were analysed for floor and ceiling effects, inconsistent responses, missing responses and differences in health states between age-groups and versions. Differences in reporting were determined by chi-square statistic (x2 ). Known-group validity across age (years), sex and health conditions were analysed using Spearman's rank order coefficients (rs) in addition to the median utility and Visual Analogue Scale (VAS) scores using Kruskal Wallis and Mann-Whitney U-test. Pearson's correlation was used to assess concurrent validity by comparing the utility and VAS scores between versions. Spearman's Rank Correlation was computed to assess the convergent validity of the EQ-5DY-3L-IA and SC compared to the FPS-R, MFQ and WeeFIM. Responses from structured cognitive debriefing interviews were grouped and coded by the researcher according to similar responses provided by participants. Cognitive debriefing was used to determine the acceptability, comprehensibility and where applicable, participants' preference between versions and the reasons for their preference. The researcher was aware of reflexivity and did not allow personal opinions to impact on participants' responses, nor the grouping and coding of responses. The EQ-5D-Y-3L-IA was retested 48 hours later only in children with a stable health condition, recruited from schools and analysed using weighted Cohen's kappa statistic (k) for dimension scores and the Intraclass Correlation Coefficient (ICC) for utility and VAS scores. Results There were no concerning differences in EQ-5D-Y-3L dimension responses, known-group validity, concurrent validity or correlation of VAS and utility scores between the IA and SC versions. The IA version had the advantage of no missing values and was preferred over the SC version by 8-10-yearolds (60%). When comparing the IA version between age-groups, the performance was similar. However, children aged 5-7-years reported significantly more problems with the Looking After Myself dimension (x2 =31.021; p<. 0001) by which cognitive debriefing revealed developmental difficulty with advanced dressing tasks such as laces and buttons. Conclusion Validity and test-retest reliability of the EQ-5D-Y-3L-IA version was successfully assessed in children aged 5-10-years. As the results were comparable to the SC version in children aged 8-10-years, it therefore indicates that versions can be used interchangeably. In settings with low literacy levels, such as South Africa, the IA version is recommended for young children, most notably those 8-years of age. The performance of the IA version across age-groups showed that younger children can reliably report on their HRQoL therefore also proved useful in younger age-groups, however, adaptations to the dimension of Looking after myself is suggested for improved developmental appropriateness. Therefore, it is recommended that EQ-5D-Y-3L-IA be included in children from 5-years in routine clinical practice and clinical trials.