University of Pretoria

Activities most valued by stroke survivors Tarryn James, Sophy Mothapo, Danielle Simpson, Mandy Sorour, Talia Wilmot, Jodie de Bruyn

Introduction Do we know what is most important to our stroke patients in the acute recovery period? Do we plan our treatment with our patients? Or do we follow a protocol?

Research Question What activities are most important to South African stroke survivors in an acute setting?

Aim of Study To determine which activities were most important to stroke patients in a South African setting Whether personal factors influence these priorities: Age, gender, and culture

Significance Increase the literature available on South African stroke patients Shed light on the important factors which influence priorities of stroke survivors Guide for therapists with limited experience

LITERATURE REVIEW

Occupational Therapy Meaningful activity may have different meaning in different cultures and contexts [1] Means to an end/ends in itself? Patient centered approach Collaboration between the practitioner and client [2] Greater participation from client

Occupational Therapy Through purposeful occupation, the brain is able to adapt more effectively to functional demands [3]-Motor relearning program Cortical re-organisation NB

Areas of occupation [2] Activities of daily living (ADL) Social Participation Instrumental activities of daily living (IADL) Work Rest and Sleep Education Leisure

Factors influencing activity choices Age - priorities of stroke patients.[7] Ubuntu - a person depends on persons to be a person [8] Ubuntu is universal, underlying values can be applied to all South African cultures. [9] Communities were seen as: Protection for its members [9] Responsible for caring for its members [10] A means for social participation and interaction [11] Cultures outline the gender norms [12]

RESEARCH DESIGN Quantitative Design Cross sectional

Population and Sampling Population Stroke patients receiving OT treatment at a rehabilitation unit in Pretoria Sample Convenience sampling Stroke patients receiving OT treatment at Muelmed Hospital Tshwane Rehabilitation Hospital Eugene Marais Hospital

Criteria Inclusion Stroke survivor Receiving OT at the selected rehabilitation units Fully understand/ communicate in English or Afrikaans Exclusion Aphasia Communication disorders Severe cognitive deficits History of previous neurological disorders South African citizen SA Culture

Research Instruments Background information questionnaire COPM [13] Semi-structured interview to determine problematic areas in self-care, work and leisure. Identify and rate the 5 most problematic areas Scale of importance rating: 1 (Least important) 5 10 (Most important)

Procedure * Informed consent and access to information obtained from hospitals. * Occupational Therapists of the rehabilitation unit selected possible participants according to the inclusion and exclusion criteria. * Interviews were conducted with in and out patients. Patients selected had been receiving rehabilitation at the hospitals prior to the interview.

RESULTS

Demographics Gender Race Religion Male 9 Female 9 Black 10 White 7 Coloured 1 Christian 16 Other 1 Non-religious 1

Cultural Groups Cultures Number of participants Male : Female Average age (years) Range of age (years) Afrikaans 8 5 : 3 70.6 55 84 African 10 4 : 6 64.4 52-86

Overall Rankings A bar graph of the number of responses for the different occupations (N=77) Number of responses 16 14 12 10 8 6 4 2 0 Occupation (In order of ranking)

Rankings Cultural Groups Afrikaans 1. Walking 2. Social participation family/ friend/ peer 3. Bathing and showering 4. Leisure participation 5. Dressing 6. Job performance 7. Meal preparation and cleanup 8. Community mobility 9. Transfers 10. Shopping 11. Eating 12. Home establishment and maintenance African 1. Bathing and showering 2. Walking 3. Social participation family/ friends/ peer 4. Dressing 5. Home establishment and maintenance 6. Job performance 7. Meal preparation and clean up 8. Leisure participation 9. Transfers 10. Toileting 11. Pet Management Financial management 12. Educational informal needs/exploration 13. Social participation community 14. Religious observance

Distribution of responses Afrikaans Responses (N=35) African Responses (N=42) 11% 9% 9% 6% 20% 11% 5% 5% 7% 10% 7% 2% 17% 21% Walking Bathing and Showering Social Participation family/peer/friend Dressing Job performance Home establishment and management Leisure participation 9% 3% 8% 14% 12% 14% Community mobility Meal preparation and cleanup Transfers

DISCUSSION

Areas of Occupation Top three identified areas: ADL Walking (78% of participants) Bathing and showering (72% of participants) Social participation Friends/ family/ peers (61% of participants)

Additional Results Other self-care areas did not feature as predominantly as bathing and showering # Occupation Number of Afrikaans Number of African Average rating of Afrikaans Average rating of African 8 Toileting 1 10.00 Shopping 1 10 Eating 1 9 Care of pets 1 8.00 Financial management 1 8.00 Personal education 1 7.00 Personal hygiene

Additional Results Afrikaans 1. Walking 2. Social participation family/ friend/ peer 3. Bathing and showering 4. Leisure participation 5. Dressing 6. Job performance 7. Meal preparation and cleanup 8. Community mobility 9. Transfers 10. Shopping 11. Eating 12. Home establishment and maintenance African 1. Bathing and showering 2. Walking 3. Social participation family/ friends/ peer 4. Dressing 5. Home establishment and maintenance 6. Job performance 7. Meal preparation and clean up 8. Leisure participation 9. Transfers 10. Toileting 11. Pet Management Financial management 12. Educational informal needs/exploration 13. Social participation community 14. Religious observance

INFLUENCING FACTORS

Culture Unable to conclude a relationship However: Many similarities found between African and Afrikaans Occupations = Universal Basic needs = Universal

Age Mean age = above 65 years Pensioners Work participation < Leisure & Social Participation

Limitations 1. Few participants 2. Language barriers 3. Cognitive symptoms of stroke 4. Multiple variables influencing results 5. Sampling

Suggestions 1. Increase sample size 2. Include various environmental settings 3. Explore various influencing factors 4. Alternative measurement instrument 5. Explore areas of occupations 6. Conduct research with various diagnosis

Conclusion of Objectives To determine what the initial occupational priorities of stroke survivors were. To determine whether South African cultures affected these priorities. To determine the relationship between the occupational areas identified and the participants cultural context.

Key findings Activities of daily living Functional mobility (walking) Bathing and showering Social participation

REFERENCES

1. Creek J (1998) (ed) Occupational Therapy: New Perspectives. London: Whurr Publishers 2. American Occupational Therapy Association. (2008). Occupational therapy practice framework: domain and process (2 nd ed.). American journal of occupational therapy, 62,625-683 3. Trombly CA, Radomski MV. Occupational Therapy for physical dysfunction. 5 th ed. Philadelphia: Lippincott Williams and Wilkins: 2002. 4. Legg L, Drummond A, Leonardi-Bee J, Gladman JRF, Corr S, Donkervoort M, et al. Occupational therapy for patients with problems in personal activities of daily living after stroke: systemic review of randomised trials. BMJ. 2007 Jul 30; 1-8 (no journal volume) 5. Walker MF, Leonardi-Bee J, Bath P, Langhorne P, Dewey M, Corr S, et al. Individual patient data meta-analysis of randomised controlled trials of community Occupational Therapy for stroke patients. Journal of American Heart Association. 2004 Jul 22: 34: 2226-2232 6. Moraris R, Payne O, Lambert L. Patient, Carer and staff experience of a hospital-based stroke service. International Journal for Quality in Health Care. 2007 Feb 2. 19(2):105-112

7. Kinn S, Lawrence M. Rehabilitation research and practice [internet]. Glasgow: unknown. [2012 May 21: cited 2014 Jan 20]. Available from: http://www.hindawi.com/journals/rerp/2012/963978. 8. Watson R, Swartz L, editors. Transformation through occupation. London: Whurr Publishers; 2004. 9. Kamwangamalu NM. Ubuntu in South Africa: a sociolinguistic perspective to a pan-african concept. Critical Arts: South-North Cultural and Media Studies. 1999;13(2): 24-41 10. Masango M. The African concept of caring for life. HTS.2005. 61(3). 11. Wilcock AA. An occupational perspective of health. United States of America: SLACK Incorporated; 1998. Danvers 12. Crouch R. The Relationship between culture and occupation in Africa. In: Alers V, Crouch R, editors. Occupational therapy: An African perspective. Johannesburg: Sarah Shorten Publishers;2010. p.50-59 13. Canadian Occupational Performance Model [internet]. Learn to use the COPM. [Cited 2014 Aug 16]. Available from: http://www.thecopm.ca/learn/