The use of Igisoro game in Occupational Therapy Rehabilitation in Rwanda: A mixed method design

doi:10.21203/rs.3.rs-5208821/v1

Background: The Igisoro game is a traditional board game deeply embedded in Rwandan culture, played by two participants on a specially designed board. It has been recognized for its role in fostering social, intellectual, and communication skills. The game is widely accessible and enjoyed across various settings. In particular, Igisoro is utilized in Rwandan hospitals, including mental health and physical settings, where occupational therapists incorporate it as a therapeutic tool in their interventions.

Objective:This study aims to explore the perceptions of occupational therapy professionals and their clients regarding the use of Igisoro game in rehabilitation.

Methods:The research first gathered insights from occupational therapy professionals through a cross-sectional quantitative study involving seventeen (17) occupational therapists, selected conveniently. Subsequently, the study explored the perceptions of beneficiaries through face-to-face semi-structured in-depth interviews with twelve (12) participants, recruited purposively. The sample size was determined based on data saturation.

Results:The occupational therapy professionals reported that Igisoro game improve clients’ concentration, gaining attention, expression of feelings, problem-solving skills and improving socialization were reported at higher frequencies of (88.2%), self-confidence (82%), improve judgement, fine motor skills, cognitive and perceptual skills at 76.5%, management of side effect of medication (64.7%). Furthermore, the beneficiaries’ perceptions yielded three themes namely: enhancing the socialization, stress management, and enhancing hands skills. Conclusion: The perceived benefits identified by both occupational therapists and beneficiaries align closely. Both groups recognized that the Igisoro game enhances socialization, cognitive abilities, and hand functional skills. Therefore, Igisoro should continue to be employed as a valuable therapeutic tool in occupational therapy rehabilitation.

Igisoro

rehabilitation

occupational therapy

game

beneficiaries

Igisoro, a traditional board game from Rwanda, belongs to the Mancala family of games, which are popular in East Africa and is considered one of the more complex versions (1). The exact origins of Igisoro in Rwanda are unclear, but it gained widespread popularity between 1312 and 1345 during the reign of Ruganzu I (2).The game continued to be widely played between 1510 and 1543 under the rule of Ruganzu II Ndoli (2). Some believe that Igisoro may have been played even before the time of Christ (2).

This game is played by two opponents on the wooden board of about 60x30 cm with 32 round holes, four rows and eight columns splitted by two portions(1). The players slide 64 pawns with a target of putting together enough of them so that there are none left for the opponent to catch (1). People typically play games for fun, enjoyment, and the pleasure of competing with others(2).

In Africa, the board games have different purpose including cultural elements transfer the intellectual skills ,cognitive strategies, attitudes and motor skills(3,4). Playing Igisoro demands passion and intensity, as it is a competitive game where two opponents strive to outmaneuver each other(2). Board games like Igisoro have specific rules and objectives that drive players to engage deeply (5).Therefore, players are challenged to develop problem-solving skills, which in turn enhances their creativity (5).

The board games have been tested for educational purpose and health promotion among the different age groups of population. The studies showed that the board games enhance the individual’s capacity of cognitive ability, perceptions, memory, and thinking capacity(4,6). Furthermore, board games help in building cultural life style in sense that they increase the capacity to control their emotions and improve mental capacity (8).

The mancala board game including Igisoro has been played as way of socialization in many African cultures including Rwanda. Therefore the mentally ill populations including drug addicted , psychosocial and behavioural disorders benefit from the board games including Igisoro (15)(16)(17). In addition the literature showed that it can also help in population with physical dysfunctions while working on the upper body functional skills (18). Older persons play Igisoro game to improve health and slow down age related declines (19).

According to the study conducted by (20), showed that the board games improved the physical life, energy level, balance and strength of the elderly population in the nursing home. In addition, playing board game involves smooth and coordinated body parts movements together with trunk stability and in-hand manipulation skills (21). The Igisoro game is played as means to the restoration of lost fine motor components that will eventually be needed in a variety of occupations (22). The integration of board games in stress management program for the clients with depression and anxiety lead to decrease in negative emotional state as well it displayed the important role during the long-time of quarantine , for instance the recent COVID-19 pandemic (20)(23).

The Igisoro game reflects the culture, behaviour, and attitudes that form the foundation of daily life for individuals (10). Therefore, incorporating Igisoro into occupational therapy rehabilitation is highly relevant, as it offers culturally meaningful motivation for skill learning and development(10). Although Igisoro is currently used in various rehabilitation settings in Rwanda, there is lack of study on its use in rehabilitation. As a result, researchers are interested in exploring the perceptions of occupational therapists and beneficiaries regarding the use of Igisoro in occupational therapy rehabilitation in Rwanda.

Study aims and objectives

The primary aim of this research is to explore the perceptions of occupational therapy (OT) professionals and beneficiaries on the use of Igisoro game in rehabilitation. The study has three specific objectives; (1) to identify the perception of occupational therapists on the use of Igisoro game as interventional approach and perceived benefits, (2) to identify occupational therapy clients who can benefit from Igisoro game as interventional approach, (3) to explore the perceptions of occupational therapy beneficiaries on the therapeutic benefit of Igisoro game in the context of Rwanda.

Study design

A mixed method, exploratory design was used. The exploratory mixed methods approach involved combination of qualitative and quantitative data collection and analysis. This mixed-method approach was used to address the limitations of a single method, thereby enhancing the validity and reliability of the research findings of the use of Igisoro game in occupational therapy rehabilitation.

Study setting

The study was conducted in Rwanda at the following settings namely: Rwanda Military Hospital, Ndera Neuropsychiatric hospital, CARAES Butare, Icyizere psychotherapeutic centre, Kigali University Teaching Hospital, King Faisal Hospital, HVP-Gatagara Nyanza and Gikondo branch, Love with Actions, Partners in Health (Rwinkwavu, Kirehe). The study settings were selected basing on available qualified occupational therapists at the aforementioned settings.

Study population

The study population was comprised of two categories including occupational therapists (OT) practicing in aforementioned study areas and occupational therapy beneficiaries (Ben) from Ndera Neuropsychiatric Hospital (Ben. With mental disorders) and Rwanda Military Hospital (Ben. With physical dysfunctions). Seventeen (17) occupational therapists were from different practicing areas as illustrated in the results section whereas twelve (12) occupational therapy beneficiaries were comprised of four beneficiaries from Rwanda Military Hospital and eight from Ndera Neuropsychiatric Teaching hospital.

Sampling methods and sample size

Convenient sampling methods was used in selection of the study participants (17) practicing occupational therapists working in the aforementioned settings. A purposive sampling was used in the selection of beneficiaries from the selected settings, with suitable characteristics as by researchers’ purpose. Twelve beneficiaries involved in study from Rwanda Military Hospital and Ndera Neuropsychiatric Teaching hospital using purposive sampling to represent the various areas including paediatric, neurological, orthopaedic and mental health. The sample size of twelve study participants were attained based on theme saturation as the researchers analysed the data concurrently the data collection.

Selection criteria for occupational therapists

Licenced practicing occupational therapist
At least one year of practicing experience

Selection criteria for beneficiaries

Inclusion criteria

Being able to verbally communicate
Have been attended OT services
Having been exposed/ have information on Igisoro game

Exclusion criteria

Beneficiaries aged less than 18 years and no caretaker for consenting
Beneficiaries with no basic information on Igisoro game
Beneficiaries without verbal communication

Instrumentation

This study used two instruments for data collection. Those instruments are a self-generated semi-structured questionnaire and translated semi-structured interview.

A self-generated semi-structured questionnaire and translated semi-structured interview were developed by the consensus team of the researchers with different background from teaching hospitals, University of Rwanda, Rehabilitation centres and Refugee camps. During the generation of these instruments the researchers referred to literature review and focused discussion before coming up to agreed decision.

A self-generated semi-structured questionnaire is constituted with the different questions regarding to background of occupational therapy practitioner and his/her experience in the use of Igisoro game in occupational therapy rehabilitation.

Furthermore, semi-structured interview consisted of open questions regarding the beneficiaries’ views on the use of Igisoro game in rehabilitation. The in-depth face-to face interview was conducted by three researchers with more than four years of experience in occupational therapy rehabilitation. The interviews were conducted in Kinyarwanda to allow the beneficiaries to freely provide their insights on the research interview questions.

Trustworthiness

Rigor of research was followed during research process which are credibility, dependability, conformability and transferability main to ensure that qualitative data are well incorporated.

Credibility: It is explained as authentic and accurate (27). It is about realistic data. This was achieved through member checking and peer review in order to ensure that the data is representative of the experience of the research participants. This research was conducted by a team of five researchers which was an added advantage to ensure credibility. Transferability: It proposes that results in the present research was the same as results in the same situation and research findings was appropriate for use in future (28). Concept of thick description and appropriate sampling techniques was used to ensure transferability.

Dependability: This refers to the accuracy and consistency of the research process (29).It was achieved through an audit trail with a detailed description of research process and peer review (discussions with colleagues and experienced researchers) by receiving inputs and feedback. Confirmability: Implies that how much others confirm the research findings. The review methods by research participants, colleagues’ reviews, overview of conflicting cases, and careful explanation of details are used to improve (27). It is about having the same findings at various time in a study. During this study, a team of researchers kept organizing meeting for discussions to make sure that this research is conducted well. Mixed methods was used to ensure varieties of research information and inputs from different research participants (both OT practitioners and beneficiaries).

Data collection procedures

After obtaining ethical approval from the Institutional Review Board at UR-CMHS, permissions for data collection were requested and granted by Rwanda Military Hospital (RMH) and Ndera Neuropsychiatric Teaching Hospital (NNPTH).

Researchers reached out to occupational therapists to obtain their active email addresses. Informed consent forms were sent via email, along with a self-generated semi-structured questionnaire through Google Forms. A first reminder was sent after one week, with a final reminder following at the end of three weeks, encouraging the completion of the questionnaire.

For occupational therapy beneficiaries at RMH and NNPTH, researchers visited the facilities and approached potential participants to explain the study's objectives. Informed consent was obtained prior to data collection. Subsequently, in-depth face-to-face interviews were conducted at the beneficiaries' settings, with each interview lasting 20-30 minutes. These interviews were audio-recorded, and key points were noted for further analysis.

Data analysis process

Descriptive analysis was used to measure quantitatively the study objectives. Frequencies and percentages were calculated to measure the reported clients who can benefit Igisoro game and perceived benefits from the occupational therapy practitioner’s perspectives. An inductive thematic analysis and Atlas.ti. version 23 software were employed to analyse qualitative data. The researchers followed these steps: (1) generating transcripts, (2) reading and re-reading transcripts, the transcripts were familiarized, (3) generating codes using Atlas.ti. version 23, (4) searching for theme, involves grouping different codes to make the sub-theme, (5) generating theme, (6) producing constructed report. The researcher’s consensus agreed on the generated themes after consideration of the similarities and differences.

Ethical consideration

The ethical clearance was sought from the Institutional Review Board at the University of Rwanda, College of Medicine and Health Sciences (UR-CMHS) with reference number ( No 235/CMHS IRB/2023), the Ethics Committee of at Rwanda Military Hospital (REF 184/RMH/COMDT/2024) and Ethics committee at Ndera Neuropsychiatric Teaching Hospital (No 005/NNPTHEC/2024). Participation in the study was voluntary, signed consent and/or assent form was obtained from the study participants. The study participants were freely to ask any question or any worries related to the research at any time. They were free to withdraw from the research anytime they want and no further impact associated with his/her withdrawal from the study. The data confidentiality was ensured by using pseudonyms during the data collection and analysis. Furthermore, the research abide to World Medical Association (WMA) declaration of Helsinki – ethical principles for medical research involving human subjects(30).

Table 1

**Demographic characteristics of participants of occupational therapists**
	Demographic characteristics of participants of occupational therapists
		Frequency	Percentages
Gender	Male	9	52.9
	Female	8	47.1
Years of experience	2–3 years	6	35.3
	3–4 years	7	41.2
	4–5 years	1	5.9
	More than five years	3	17.6
Area of practice	Paediatrics	13	76.5
	Orthopaedic condition-adult	6	35.3
	Neurological conditions	9	52.9
	Mental Health	5	29.4
	school setting	2	11.8
	Geriatrics	1	5.9
Working setting	CHUK	1	5.9
	HVP-GATAGARA	6	35.3
	Ndera-Neuropsychiatric Teaching Hhospital	4	23.5
	PIH	2	11.8
	Unique Rehabilitation centre	1	5.9
	RMH	1	5.9
	Love with action	2	11.8
Level of education	Diploma in OT	1	5.9
	Bachelor degree in OT	16	94.1
Using Igisoro in OT treatment	yes	8	47.1
	No	9	52.9

The male and female participants were almost equal in number 9 and 8 respectively. Their years of experiences is mainly between 2–4 years counting 76.5%. The work places include hospitals, schools and rehabilitation centres serving for clients with different health conditions. The majority of occupational therapists completed bachelor’s degree (94.1%). Almost, half of the occupational therapists indicated that they are using Igisoro game as an interventional approach.

Perceptions of occupational therapists on the use of Igisoro game as an interventional approach

Occupational therapists perceived benefits of Igisoro game in rehabilitation

The findings from occupational therapists revealed the perceived benefit of using Igisoro game in occupational therapy rehabilitation. It was found to improve patients’ concentration, gaining attention, expression of feelings, problem-solving skills and improving socialization were reported at higher frequencies of (88.2%), self-confidence (82%), improve judgement, fine motor skills, cognitive and perceptual skills at 76.5%, management of side effect of medication (64.7%) (Fig. 1).

Categories of clients ‘conditions benefiting Igisoro game as intervention

The reported clients’ medical conditions that may benefit from using the Igisoro game during rehabilitation. The conditions reported with a high frequency (82.4%) include neurological conditions, geriatric conditions, anxiety, and mood disorders, psychotic disorders (76.5%) and substance abuse (64.7%). This indicates a significant need to incorporate the Igisoro game in the rehabilitation process for these conditions from the perspectives of occupational therapists (Fig. 2).

The perceptions of occupational therapy beneficiaries on the therapeutic benefit of Igisoro game

Three themes with their corresponding sub-themes were generated, explaining the beneficiaries’ perceptions on the benefits of Igisoro game in rehabilitation. Theme1: enhancing hand skills with sub-themes: dexterity/fine motor skills, hand muscle strengthening tasks, and hand mobilization. Theme2: stress management with sub-themes: preventing self-focused thinking and improving positive thoughts. Theme 3: enhancing socialization with sub-themes: improving social interaction, preventing social isolation, engaging in leisure activities, and promoting relaxation.

Theme 1: Enhancing hand skills

This theme encompasses the following sub-themes: dexterity/fine motor skills, hand muscle strengthening tasks, and hand mobilization.

1.1 Dexterity/Fine Motor Skills

The Igisoro game, which involves picking and moving seeds (insoro), has been reported by occupational therapy beneficiaries to improve dexterity and fine motor skills. Engaging in this game requires the use of hands, thereby enhancing fine motor control.

"Knowing that the Igisoro game requires the use of hands, I think it can be part of an exercise that helps my hand." [P9, P1, P3]

"It (igisoro game) can help people who have limitations in using their hands." [P12, P7]

"It helps in participating in activities that require hand use." [P4]

"It works on my fingers when I grasp seeds (insoro)." [P5]

1.2 Hand muscle strengthening tasks

Playing the Igisoro game has also been reported to improve the strength of hand muscles, including those in the fingers. The game requires players to use their hands by picking seeds, moving hand and releasing the seeds which can increase muscle strength through repeated movements.

"I believe the hand muscles can work again, and I will be able to use my hand." [P9]

"It helps to strengthen my fingers, and afterward, I perform well in some activities." [P8]

1.3 Hand mobilization

The active movement required in the Igisoro game facilitates the improvement of hand and arm range of motion. Moving and reaching the seeds from one hole to another involves hand and arm activity.

"I believe it can help people extend their arms." [P10]

"It mobilizes my fingers and arms to regain mobility." [P11]

"People try to use their hand while picking and releasing the seeds." [P2]

Theme 2: Stress management

This theme presents the following sub-themes: preventing self-focused thinking and improving positive thoughts

2.1 Preventing self-focused thinking

The Igisoro game has been reported as an effective occupation-based intervention, as it engages patients and prevents them from focusing on their own difficulties and challenges.

"It is a good game that helps a person not to think about herself." [P1, P7, P10]

"Having something to do, like playing with friends and conversing, helps to distract from self-focused thoughts." [P10]

"It brings joy; it takes time and keeps you busy, preventing self-focused thinking." [P3]

2.2 Improving positive thoughts

Occupational therapy beneficiaries have found the Igisoro game to be a beneficial intervention for fostering positive thoughts. By engaging in the game, which is typically played with a partner, patients are distracted from negative thinking and engage in conversation, which helps shift their mindset.

"It can improve positive thoughts by relieving stress." [P9, P12]

"It helps in developing a positive mindset toward life and friends." [P3, P11]

Theme 3: Enhancing socialization

This theme encompasses the sub-themes of improving social interaction, preventing social isolation, engaging in leisure activities, and promoting relaxation.

3.1 Improving social interaction

The Igisoro game has been reported by occupational therapy beneficiaries to significantly enhance social interaction. through playing, talking, and sharing experiences with others, participants are able to meet new people and strengthen existing friendships. This improvement in social interaction enables patients to integrate more fully into their communities and families, participating in everyday tasks with effective communication skills.

"Igisoro is played by two people and fosters socialization." [P2, P10]

"It is a fair play that helps people interact and develop friendships." [P3, P4]

"It helps me interact with my friends and play a game I enjoy." [P3, P5, P4]

"Igisoro helped me interact with others." [P5, P8]

"It aids social interaction and helps in planning for future wins." [P3]

3.2 Preventing social isolation

The Igisoro game also serves as an effective intervention to prevent social isolation among patients. By engaging in the game with others, patients reduce the tendency to be alone, thereby improving their mental health through social interaction.

"Especially those clients with social isolation, when they start playing with others, therapists noticed important improvements." [P2]

"Playing with others prevents isolation." [P7, P6]

"Igisoro helps me avoid loneliness and feel better." [P6, P8]

3.3 Leisure activity

Playing the Igisoro game has been identified as a leisure activity that brings joy, entertainment, and a sense of encouragement. Patients experience motivation and enjoyment through the competitive nature of the game, which boosts their self-esteem as they strive to win against their opponents.

"It can help relieve stress as a form of enjoyment and entertainment." [P1, P7, P11]

"Brings motivation and enjoyment when seeing someone win." [P2, P4]

3.4 Promoting relaxation

Occupational therapy patients also reported that playing the Igisoro game aids in relaxation. It is found to calm the mind and provide a restful, cool, and calm state of being.

"Igisoro game helps in relaxing the brain." [P1, P8]

"Igisoro game helps to relax our mind and really helps people to rest." [P4]

This study explored the use of Igisoro game in occupational therapy rehabilitation as the interventional approach, by exploring the occupational therapist perceptions and beneficiaries on benefits use of Igisoro game. The occupational therapist reported that persons with neurological conditions, geriatric conditions, anxiety, mood disorders, and psychotic disorders benefit the Igisoro game with frequency above 70% of the total respondents of the occupational therapist. These show that the Igisoro game is the rehabilitation approach in the mentally ill people and those with neurological disorders. It is in the light of the nature of the disorders, whereby the mental health disorders present with the behavioural issues, mood and cognitive deficits, and neurological disorders present fine motor skills deficits and cognitive as well (31).This is consistent with the reported perceptions of the occupational therapist on the use of Igisoro during the occupational therapy rehabilitation.

Perceived benefits on the use of Igisoro game during Occupational therapy rehabilitation

Occupational therapy participants emphasized the multiple advantages of Igisoro games for cognitive, social, and physical skills. Occupational therapy beneficiaries who utilize the Igisoro game reported that it promotes socializing, stress management, and leisure activity.

Perceived benefits of improving cognitive skills and stress management

It was discovered to be an effective technique for improving attention and concentration, especially among people with cognitive deficits. The study participants stressed that the Igisoro game improves problem-solving, critical thinking, and mental acuity, serving as a tool for cognitive rehabilitation. Similarly, to this study noted (31) that the board games including Igisoro improves the cognitive deficits of attentions, concentration, memory and judgement. By participating in Igisoro game, the persons with cognitive deficits mighty gain the important skills to participate in everyday life activities such as work, activities of daily living and capable to manage the behaviors during the engagement with others. Furthermore, the management of stress, prevention of self-focused thinking and improving positive mindset were reported as benefit of the use of Igisoro game by occupational therapy beneficiaries. In the previous studies, board games were found to help in building cultural life style in sense that they increase the capacity to control their emotions and improve mental capacity (8).This helps people’s to abide to cultural based games, appropriate behavior and attitudes required for every day’s life of the person(10). It has been demonstrated that people with mental problems use this game to manage stress by using their time, staying busy, and not thinking about themselves because they are mentally sick at the moment. Not only that, but they also play the game as a leisure activity, which is typically held in the community. As a result of stress management, people can participate in activities they were previously unable to participate in while being productive and engaged in their daily lives.

Perceived benefits of improving socialization

Igisoro game was also acknowledged by the occupational therapist for its role to improve communication and socialization; this serves to be as the community leisure activity. Like it is rooted in Rwandan culture where the community neighbours gather to play and reinforce community bonds (32). This is the line of reported benefits by of the occupational therapy beneficiaries who use Igosoro game during rehabilitation. Beneficiaries expressed that it improves social interaction, preventing social isolation, engaging in leisure activities, and promoting relaxation, and enjoyment. This is supported by the literatures explaining that the persons play the games with the goal of having fun, enjoyment and pleasure with playmates(2). It was found also that board games are still used as the entertainment, life skills transmission, social, and verbal skills in the daily life of the African people (7). The improved social skills through playing Igisoro game enable the persons with mental problems to recognize their participation in group activities, collaboration and working a team during at work, and everyday life activities.

Perceived benefits of improving the hand functions

Igisoro was recognized for its benefits in promoting fine motor skills and eye hand coordination. The physical act of moving marbles or seeds across the board requires dexterity, thus helping elderly players maintain their fine motor abilities. Furthermore, the occupational therapy beneficiaries supported Igisoro game role in improving hand function such as dexterity/fine motor skills, hand muscle strengthening tasks, and hand mobilization both for patients with neurological conditions and those with mental health conditions facing hand problems as the side effect of psychotic medications. This finding is similar to the literatures which showed that board games including Igisoro can help individuals with physical impairments particularly the upper body impairments to improve functional skills (18) as they involve smooth and coordinated body parts movements with trunk stability and in-hand manipulation skills (21). It was also found to restore lost fine motor components that are needed in a variety of occupations using the hands(22).

Strengths, limitations of the study and recommendations

The study incorporated the occupational therapists who had the experience in using Igisoro game as therapeutic tool during the rehabilitation. The occupational therapists work in mental health hospital and physical settings. Furthermore, the study design used were quantitatively whereby the occupational therapist reported the benefits use of Igisoro game quantitatively and the beneficiaries from the mental health setting (participants with mental disorders) and physical setting (participants with physical dysfunctions) reported qualitatively by face-to-face in-depth interview.

This study had some limitation, the study should not be generalized to all mental health settings and physical for occupational therapy interventions using Igisoro game as therapeutic tool, this mighty contextualized on those two used settings where beneficiaries benefited the use of Igisoro. Thus, recommending the study from many beneficiaries and study settings. Additionally, the researchers recommend further randomized control trial to test the benefits in people with mental problems and physical problems to improve the reported benefits of this study. Finally, there were no studies on Igisoro game specifically that shows its benefits however, the studies conducted were generally mentioning the board game where Igisoro game is classified.

The following recommendations are provided:

For occupational therapists: To incorporate Igisoro game in occupational therapy services offered for clients with mental health conditions and hand problems. Interests of the clients and prior knowledge on how to play Igisoro has to be considered before engaging the clients.
Although the effectiveness of Igisoro game was not explored in the current study, it is ideal benefit should be used to help clients with varieties of problems
For the hospitals: To purchase Igisoro (Ibisoro in plural) as tools to be used by the therapists to serve the clients.
Further study is required to assess the effectiveness of Igisoro game as rehabilitation intervention in occupational therapy.

Igisoro game was found to be beneficial in occupational therapy rehabilitation services delivery for clients with mental health conditions by promoting socialization through social interaction, using it as leisure activity, improving the cognitive skills by working on the attention deficits, problem solving, concentration, and stress management by being occupied and stop thinking on themselves. Furthermore, improved the hand functional skills of fine motor skills, strengthening hand muscles and hand mobilization. Therefore, the perceived benefit of Igisoro game has been identified to help people with problems ranging from cognitive, physical skills, behavioural and neurological problems. Despite of its effectiveness and supporting literatures were limited.

OT

Occupational Therapy

UR-CMHS

University of Rwanda, College of Medicine and Health Sciences

Ethics approval and consent to participate

This study was approved by the Institutional Review Board at the University of Rwanda, College of Medicine and Health Sciences (No235/CMHS IRB/2023) and the Ethics Committee of at Rwanda Military Hospital (REF 184/RMH/COMDT/2024) and Ethics committee at Ndera Neuropsychiatric Teaching Hospital (No 005/NNPTHEC/2024). Informed written consent to participate in the study was obtained from all participants.

Consent for publication

Informed consent for inclusion of the image that is attributed to the artists and thereby identifies them has been obtained for publication in an online open access publication.

Availability of data and materials

The datasets generated and/or analysed during the current study are not publicly due to potential that transcripts and interviews with participants may lead to their identification but are available from the corresponding author on reasonable request.

Competing interests

The authors declare no conflict of interest associated to this study.

Funding

The study project has not received any funding

Authors’ contribution

PDT, JN, EM,CH, JCT contributed to the conception and design of the work, data collection, data analysis, writing the manuscript and approval of final version for submission.

Acknowledgement

The authors acknowledge the participants of this study both occupational therapists and occupational therapy beneficiaries. The hospitals are also acknowledged for granting the permission to conduct this study.

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No competing interests reported.

The use of Igisoro game in Occupational Therapy Rehabilitation in Rwanda: A mixed method design

Status:

Version 1

Abstract

Figures

Background of the study

Method and materials