The validity of the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire in Afrikaans for the Western Cape of South Africa.

Health and Rehabilitation Sciences: Occupational Therap

Cognitive Interviewing during Pretesting of the Prefinal Afrikaans for the Western Cape Disabilities of the Arm, Shoulder and Hand Questionnaire following Translation and Cross-Cultural Adaptation

When patient-reported measures are translated and cross-culturally adapted into any language, the process should conclude with cognitive interviewing during pretesting. This article reports on translation and cross-cultural adaptation of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire into Afrikaans (for the Western Cape). This qualitative component of a clinical measurement, longitudinal study was aimed at the pretesting and cognitive interviewing of the prefinal Afrikaans (for the Western Cape) DASH questionnaire highlighting the iterative nature thereof. Twenty-two females and eight males with upper limb conditions were recruited to participate at public health care facilities in the Western Cape of South Africa. Cognitive interviews were conducted as a reparative approach with an iterative process through retrospective verbal probing during a debriefing session with 30 participants once they answered all 30 items of the translated DASH questionnaire. The sample included Afrikaans-speaking persons from low socioeconomic backgrounds, with low levels of education and employment (24 of 30 were unemployed). Pragmatic factors and measurement issues were addressed during the interviews. This study provides confirmation that both pragmatic factors and measurement issues need consideration in an iterative process as part of a reparative methodology towards improving patient-reported measures and ensuring strong content validity

Occupational therapy hand assessment practices: Cause for concern?

Introduction: Assessment is critical for measuring improvement, or lack thereof, and demonstrating the outcome of intervention. In response to the lack of research in this area, this study aimed to determine the assessment practices of occupational therapists working with clients with hand conditions. Methods: A quantitative cross sectional survey design was used. A convenience sample of occupational therapists was recruited from five provinces. Respondents completed a questionnaire developed for the study that comprised demographic information, assessments used, frequency of use and factors influencing assessment choice. Data were analysed with Statistica version 11. Results: Eighty-one respondents (n=114) completed questionnaires representing a 71% response rate. Goniometry (84.0%), manual muscle testing (76.5%) and testing for flexor tendon function (76.3%) were used most frequently. The most common reasons for not using assessments were lack of availability and unfamiliarity. Conclusion: It is of concern that the assessment practices of participants in this study focussed primarily on the assessment of body function and structure with few therapists using activity and participation measures. This could seriously limit the evidence needed to verify the outcomes achieved through occupational therapy intervention in the treatment of hand conditions

Towards the clinical implementation of pharmacogenetics in bipolar disorder.

BackgroundBipolar disorder (BD) is a psychiatric illness defined by pathological alterations between the mood states of mania and depression, causing disability, imposing healthcare costs and elevating the risk of suicide. Although effective treatments for BD exist, variability in outcomes leads to a large number of treatment failures, typically followed by a trial and error process of medication switches that can take years. Pharmacogenetic testing (PGT), by tailoring drug choice to an individual, may personalize and expedite treatment so as to identify more rapidly medications well suited to individual BD patients.DiscussionA number of associations have been made in BD between medication response phenotypes and specific genetic markers. However, to date clinical adoption of PGT has been limited, often citing questions that must be answered before it can be widely utilized. These include: What are the requirements of supporting evidence? How large is a clinically relevant effect? What degree of specificity and sensitivity are required? Does a given marker influence decision making and have clinical utility? In many cases, the answers to these questions remain unknown, and ultimately, the question of whether PGT is valid and useful must be determined empirically. Towards this aim, we have reviewed the literature and selected drug-genotype associations with the strongest evidence for utility in BD.SummaryBased upon these findings, we propose a preliminary panel for use in PGT, and a method by which the results of a PGT panel can be integrated for clinical interpretation. Finally, we argue that based on the sufficiency of accumulated evidence, PGT implementation studies are now warranted. We propose and discuss the design for a randomized clinical trial to test the use of PGT in the treatment of BD

An efficient strategy for evaluating new non-invasive screening tests for colorectal cancer: the guiding principles

Objective: New screening tests for colorectal cancer (CRC) are rapidly emerging. Conducting trials with mortality reduction as the end point supporting their adoption is challenging. We re-examined the principles underlying evaluation of new non-invasive tests in view of technological developments and identification of new biomarkers. Design: A formal consensus approach involving a multidisciplinary expert panel revised eight previously established principles. Results: Twelve newly stated principles emerged. Effectiveness of a new test can be evaluated by comparison with a proven comparator non-invasive test. The faecal immunochemical test is now considered the appropriate comparator, while colonoscopy remains the diagnostic standard. For a new test to be able to meet differing screening goals and regulatory requirements, flexibility to adjust its positivity threshold is desirable. A rigorous and efficient four-phased approach is proposed, commencing with small studies assessing the test’s ability to discriminate between CRC and non-cancer states (phase I), followed by prospective estimation of accuracy across the continuum of neoplastic lesions in neoplasia-enriched populations (phase II). If these show promise, a provisional test positivity threshold is set before evaluation in typical screening populations. Phase III prospective studies determine single round intention-to-screen programme outcomes and confirm the test positivity threshold. Phase IV studies involve evaluation over repeated screening rounds with monitoring for missed lesions. Phases III and IV findings will provide the real-world data required to model test impact on CRC mortality and incidence. Conclusion: New non-invasive tests can be efficiently evaluated by a rigorous phased comparative approach, generating data from unbiased populations that inform predictions of their health impact

Introducing early active mobilisation following flexor tendon repair in the context of care in a developing country : a randomised feasibility study

CITATION: Buttle Naude, A. & De Klerk, S. 2019. Introducing early active mobilisation following flexor tendon repair in the context of care in a developing country : a randomised feasibility study. South African Journal of Occupational Therapy, 49(2):48-56, doi:10.17159/23103833/2019/vol49n2a8.The original publication is available at http://www.sajot.co.zaIntroduction: Flexor tendon injuries remain one of the most difficult hand injuries to manage post-operatively. Early active mobilisation protocols are considered ‘best practice’ internationally but have not been well researched in the developing country context. The feasibility of such research, and use of these protocols, need to be determined by considering the potential for improved functional outcomes for patients, together with various contextual and resource challenges. Purpose: To explore aspects of feasibility related to the recruitment, consent and retention rates in consideration of a future definitive Randomised Control Trail. In addition, preliminary results of an early active therapy protocol compared to an early passive therapy protocol were reported on, together with patient satisfaction and demographics. Methods: A parallel randomised pilot trial design was used. Thirty-one participants were recruited into one of two therapy groups (active or passive). Fourteen of these participants completed their therapy and eight-week assessments including: Total Active Motion, grip strength, the Michigan Hand Questionnaire and the Smith Hand Function Evaluation. 95% Confidence intervals examined feasibility data. Non-parametric data analysis was done primarily using medians and ranges. Results: Feasibility results of 37% recruitment rate, 97% consent rate and 45% retention rate, did not meet the criteria for success, deeming a trial in the present design, not feasible. Discussion: Due to the dearth of research from public health clinical settings in developing countries, this study contributes rich contextual data, but the challenges discussed need to be addressed before further research will achieve success.Publisher's versio

Workplace-based rehabilitation for upper limb conditions in the South African context

CITATION: Hoosain, M., De Klerk, S. & Burger, M. 2019. Workplace-based rehabilitation for upper limb conditions in the South African context. South African Journal of Occupational Therapy, 49(2):57-60, doi:10.17159/2310-3833/2019/vol49n2a9.The original publication is available at http://www.sajot.co.zaWorkplace-based rehabilitation is a growing field of practice internationally and locally. This commentary discusses the current barriers and facilitators facing South African occupational therapists wanting to implement workplace-based rehabilitation with upper limb conditions. An overview is provided of current international practice in the field and relevant factors in the South African context. Recommendations are made for development in this field in clinical practice, research and education in South Africa.Publisher's versio

The validity and clinical utility of the Disability of the Arm, Shoulder and \hand (DASH) questionnaire for upper limb injuries in developing country contexts: A systematic review

Objective: South Africa is a developing country with inequality and diversity in terms of culture, language and occupations. The high incidence of violence and trauma contributes to upper limb injuries. Patient rated outcome measures, such as the Disability of the Arm Shoulder and Hand Questionnaire (DASH), should be routinely implemented in order to evaluate the end result of intervention. Specific outcomes of interest are aspects of activity and participation according to the nine domains outlined in the International Classification of Functioning Disability and Health (ICF). This paper will review the evidence available on the validity and clinical utility of the DASH as a measure of activity and participation in patients with upper limb injuries in developing country contexts where inequality exists. Methods: A comprehensive search of key electronic databases, including MEDLINE (PubMed), EBSCOHost, CINAHL, Science Direct, Scopus and Web of Science, will be conducted. Grey literature will also be considered as far as possible. Articles meeting the following inclusion criteria will be included in the review: 1) reporting on the use of the DASH as an outcome measure for upper limb injured patients; 2) from countries with a Gini coefficient of 0.50 and above and; 3) that provide evidence on the validity and clinical utility of the instrument. The methodological quality of selected studies will be independently assessed by two researchers using the critical appraisal tool developed by the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) group. Results: Results will be reported by means of a study flow diagram showing the search strategy. Study characteristics will be summarized including psychometric properties assessed and results. Risk of bias will be assessed and reported using the COSMIN criteria. Conclusion: This review will provide a critical analysis of the psychometric properties of validity and clinical utility of the DASH in traumatic hand injuries assessed in developing countries. Recommendations for practice and future research will be made