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Theses and dissertations (Health Sciences)

Permanent URI for this collectionhttp://ir-dev.dut.ac.za/handle/10321/12

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    A practice framework to improve accessibility of maternal healthcare services for women with disabilities in KwaZulu-Natal, South Africa
    (2023-05-31) Mheta, Doreen; Sibiya, Maureen Nokuthula; Nkosi, Pauline Busisiwe
    Background Access to maternal healthcare services is a challenge in most low and middleincome countries. South Africa is one of the countries striving to improve the accessibility of maternal healthcare services. Although South Africa has put some interventions to improve the accessibility of maternal healthcare services, vulnerable women including women with disabilities are still facing numerous challenges when trying to access maternal healthcare services. Aim The aim of the study was to explore the factors that impact access to public maternal healthcare services for women with disabilities in KwaZulu-Natal with the ultimate goal of developing a practice framework to improve women with disabilities’ access to maternal healthcare services. Methodology An in-depth qualitative study was conducted using the case study method. Interviews and focus group discussions were used to collect data. Twelve women with disabilities (four with physical impairments, four with hearing impairments and four with visual impairments) were interviewed for this study. Focus group discussions were conducted with sixteen midwives and one-on-one interviews were conducted with four gynaecologists and one medical officer. Data were transcribed verbatim and analysed utilising the framework of assessing access to maternal healthcare services by Peters et al. 2008: 162. Findings Several factors impact access to maternal healthcare services for women with disabilities. They are classified into systemic, infrastructural and personal. These factors are interconnected to either positively or negatively impact access to maternal healthcare services for women with disabilities. Systemic factors include availability of human resources, training on handling pregnant women with disabilities and availability of sign language interpreters. Infrastructural factors include the design and layout of buildings, adjustable equipment, and assistive devices. Personal factors include attitudes of healthcare workers to pregnant women with disabilities, empowerment amongst women with disabilities, availability of a companion and the ability to read and write.
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    The effect of talocrural joint manipulation on muscle activity of the lower limb, balance, pain and disability in participants with chronic ankle instability syndrome
    (2019-09-05) McLaren, Murray James; O’Connor, Laura; Puckree, Threethambal
    Background and Purpose: Ankle sprain injuries are prevalent in both the sporting and general population and can develop into chronic ankle instability syndrome (CAIS). When this occurs, there is a tendency for the ankle to re-sprain following an acute ankle sprain. Deficits in proprioception and neuromuscular control, specifically of the peroneal muscles, may lead to altered balance and postural stability in patients with CAIS. Recent research suggests that the ankle invertors and plantarflexors are also affected. Joint manipulation has been shown to result in reduced pain and improved foot and ankle functioning in individuals with CAIS, however, the exact mechanism(s) through which joint manipulation brings about these effects is not clear and the field of extremity joint manipulation on arthrogenic muscle inhibition (AMI) is under-investigated. This study aimed to determine the immediate effect of talocrural joint manipulation on postural stability and the muscle activity of the ankle invertors, evertors and plantarflexors by assessing surface electromyography (sEMG) of these muscles during static single-limb postural stability testing. Subjective outcomes of pain and disability were also measured through the use of the foot and ankle disability index (FADI). Methods: This study used a randomized, single blinded placebo controlled pre-test, and a repeated post-test measures experimental design. A sample of 42 participants, with grade I or II CAIS, aged 18-45 years, were randomly allocated into two groups. One group received a long axis distraction talocrural joint manipulation and the other group, a sham manipulation. General pain and disability (FADI), postural stability (Biosway Portable Balance System) and muscle activity (Biopac wireless EMG system) measurements were taken before the intervention. Muscle activity and postural stability were assessed again immediately after the intervention and then again 20 minutes later. Postural stability and muscle activity were measured both with participants’ eyes opened and eyes closed. FADI measurements were taken 24 hours after the intervention. Results: The two groups were comparable at baseline for age, gender, body mass index, pain and disability, postural stability and muscle activity (p > 0.050). An inter-group analysis showed a significant improvement in FADI (p= 0.005) and general pain scores (p= 0.039) when compared to the placebo group post-manipulation. There were no significant changes in the manipulation group for muscle activity and postural stability when compared to the placebo group (p > 0.050). Intra-group analysis showed an overall improvement over time for eyes opened postural stability in the manipulation group (p= 0.040) and decreased fibularis longus muscle activity in the placebo group with eyes open balance testing (p= 0.047) and eyes closed balance testing (p= 0.023). Conclusion: The results of this study showed that talocrural joint manipulation had a positive effect on pain and disability in individuals with CAIS. No significant differences were found between the intervention and placebo groups for limb muscle activity and postural stability. Intra-group analysis showed that the manipulation had a positive effect on eyes-open postural stability performance and that there may have been a trend of an effect of manipulation counteracting muscle fatigue experienced in the fibularis longus of the placebo group. Further investigation to further elucidate the effect of manipulation in CAIS is recommended.