Supported self-management in long-term conditions in an African context.

Self-management is an important strategy to improve quality of life, appropriately manage long-term health conditions, and reduce the economic burden of long-term health conditions. However, equitable healthcare access remains an issue, and the focus on 'self' in self-management is problematic. Our review aims to explore the conceptualisation and evolution of supported self-management in an African context and its relevance to physiotherapy. A state-of-the-art review of the literature was undertaken by the authors. The authors knowledge of the subject area and a database search retrieved recent articles exploring patients' and healthcare providers' understanding of supported self-management in Africa. Relevant articles were read, and data summaries of included studies were extracted and tabulated. Findings were organised deductively. Sixteen studies, 11 primary research, and 5 reviews (2016-2023) undertaken in a variety of sub-Saharan countries with healthcare workers (~n = 177) and people (~n = 16 115) living with a mix of non-communicable and communicable conditions were considered in this state-of-the-art review. Self-management perceptions were drawn from Western authors spanning development research and understanding of the concepts in Western thinking. We conclude that imported concepts, such as supported self-management for long-term conditions, should be considered within local health delivery solutions. These should be embedded in an understanding of traditional African health systems. Clinical implications: There is a need to develop locally derived African solutions. Self-management strategies for long-term health conditions should be developed, considering traditional holistic African health systems.

Prevalence and levels of disability post road traffic orthopaedic injuries in Rwanda.

Background: Prolonged disability resulting from road traffic injuries (RTIs) contributes significantly to morbidity and disease burden. A good understanding of the prevalence and the level of disability of orthopaedic injuries in developing countries is crucial for improvement; however, such data are currently lacking in Rwanda. Objectives: To determine the prevalence and levels of disability of 2 years post-road traffic orthopaedic injuries in Rwanda. Method: A multicentre, cross-sectional study from five Rwandan referral hospitals of 368 adult RTI victims' sustained from accidents in 2019. Between 02 June 2022, and 31 August 2022, two years after the injury, participants completed the World Health Organization Disability Assessment Schedule (WHODAS 2.0) Questionnaire for the degree of impairment and the Upper Extremity Functional Scale and Lower-Extremity Functional Scale forms for limb functional evaluation. Descriptive, inferential statistics Chi-square and multinomial regression models were analysed using R Studio. Results: The study's mean age of the RTOI victims was 37.5 (±11.26) years, with a sex ratio M: F:3: 1. The prevalence of disability following road traffic orthopedic injury (RTOI) after 2 years was 36.14%, with victims having WHODAS score > 25.0% and 36.31% were still unable to return to their usual activities. Age group, Severe Kampala Trauma Score and lack of rehabilitation contributed to disability. The most affected WHODAS domains were participation in society (33%) and life activities (28%). Conclusion: The prevalence and levels of disability because of RTOI in Rwanda are high, with mobility and participation in life being more affected than other WHODAS domains. Middle-aged and socio-economically underprivileged persons are the most affected. Contribution: This study showed that a good rehabilitation approach and economic support for the RTI victims would decrease their disabilities in Rwanda.

'Response of a South African university physiotherapy curriculum to contemporary national health needs and decolonialization priorities: rationale, content and lessons learnt'.

BACKGROUND: The undergraduate physiotherapy program at the University of the Witwatersrand, South Africa, aims to respond to global and national health needs across levels of care, with a focus on primary care. Ideally, contemporary health professionals' education focuses on a holistic approach that extends beyond addressing a patient's medical diagnosis. In South Africa, however, this approach also needs to address the country's colonial past by emphasizing decolonialization and social justice. Within this context, novel competencies are required to serve South Africans consistent with comprehensive health and disability frameworks based on the biopsychosocial approach such as the International Classification of Functioning, Disability and Health. AIM: As physiotherapy educators at the University of the Witwatersrand, we describe the rationale for the current public health and community physiotherapy curriculum in the context of decolonialization and social justice and provide an overview of the curriculum. METHOD: Narrative approach. CONCLUSION: Our curriculum is an example of a response to the 21st-century health needs of the South African population and the specific global and universal policies, philosophies, and principles that influence healthcare professionals and their service delivery. This curriculum prepares physiotherapy students to practice holistically, be responsive to health needs and contribute to decolonialization initiatives. Other programs may benefit from our experience.

The prevalence and profile of spinal cord injury in public healthcare rehabilitation units in Gauteng, South Africa.

STUDY DESIGN: Retrospective medical record review. OBJECTIVE: To determine the prevalence and describe the profile of person with SCI (PWSCI) admitted in the public healthcare sector in Gauteng, South Africa. SETTING: Specialized public healthcare rehabilitation units in Gauteng, South Africa. METHODS: Medical records of PWSCI admitted to public healthcare rehabilitation units between 01 January 2018 and 31 December 2019 were perused. Data were collected anonymously and then summarised using descriptive and inferential statistics. Significance was set at p < 0.05. RESULTS: 386 of 998 participants (38.7%) were admitted following SCI and the mean age was 36.9 years. Most participants were male (69.9%), with females significantly more likely to sustain a NTSCI (p < 0.001), which was the least common cause of SCI (34.9%). Those sustaining a TSCI were found to be significantly younger than their NTSCI counterparts (p < 0.001). Assault was the leading cause of injury (35.2%), and a positive HIV status with the presence of comorbidities were found to be significant risk factors for developing a NTSCI (p < 0.001). Most injuries were between T7-T12 (39.9%) and were complete (56.9%). The rehabilitation length of stay 85.6 days, with a mortality rate of 6.48%. CONCLUSIONS: Gauteng has among the highest global proportion of TSCI due to assault. Of interest, more females sustained a NTSCI than their male counterparts. There is a need to strengthen SCI prevention strategies, particularly targeting assault in young males and infectious causes in females and older populations. Further epidemiological and outcomes-based research is required for PWSCI.

Access to physiotherapy services in South African settings: stretching a hand to under-resourced communities with students as agents of change.

Background: Physiotherapy is a healthcare profession that enhances human functioning and prevents further disability. In addition to this physiotherapy promotes health, wellbeing and the prevention of diseases. In South Africa, physiotherapy and rehabilitation services are largely accessed by those living in urban communities and those with private medical funding. Rehabilitation is an essential component of the package of care yet these services do not reach disadvantaged communities who vitally need them. Through the equitable provision of service-learning, physiotherapy students can play a vital role in improving rehabilitation access to vulnerable communities. Aim: This paper illustrates how physiotherapy students studying at a South African university provide equitable services to disadvantaged rural and urban communities. Discussion: The first and second years of study focus on theoretical and classroom-based learning where students gain an understanding of basic principles of inclusion, equity, diversity, and self-awareness. In later years, students provide community-based services in urban and rural communities with a focus on increasing access to rehabilitation services. The clinical objectives which students are required to fulfil are guided by principles of public health and community rehabilitation. The Covid-19 pandemic highlighted the issue of poor access to rehabilitation services and the case study we provide demonstrates the roles physiotherapy students played to fill this gap. The authors offer a reflection from their involvement in physiotherapy student training and provide an example of a moment which displayed equity, diversity, and inclusion in their career. Conclusion: There is a huge gap to fill in the provision of equitable rehabilitation services for the South African population. Institutions responsible for the training of physiotherapists, or any rehabilitation profession, should realize their role in service delivery through a service-learning approach.

Views of health care users and providers: Solutions to improve the prevention of secondary health conditions among people with spinal cord injury, South Africa.

STUDY DESIGN: Explorative- qualitative study. OBJECTIVE: This study explored solutions to improve the prevention of secondary health conditions in people with spinal cord injury. SETTING: Rehabilitation hospital, South Africa. METHODS: Face to face semi-structured interviews were conducted with 21 therapists and 17 people with spinal cord injury at a public rehabilitation hospital. All the interviews were transcribed verbatim. Content analysis was conducted on the transcripts to identify proposed solutions to improve the prevention of secondary health conditions. RESULTS: The main theme that emerged was access to adequate health care. The categories linked to the main theme were: availability of health services, patient-centred care, strengthening rehabilitation care, access to resources and training health professionals. CONCLUSIONS: Access to adequate health is central to preventing and managing secondary health conditions. Care for people with spinal cord injury needs to be empowering and address rehabilitation care needs across the lifespan. The proposed solutions will inform the development of a prevention care model for secondary health conditions in people with spinal cord injury.

Services and interventions needed to prevent secondary health conditions throughout the life span of people with spinal cord injury, South Africa.

Background: Current evidence suggests a need for a care model that supports the prevention of secondary health conditions in people with spinal cord injury. Multiple complex factors influence the prevention of secondary health conditions. There is a need for holistic and systems-based prevention approaches, which target multiple levels. Objective: To identify the services and interventions needed to prevent secondary health conditions throughout the life span of people with spinal cord injury. Method: We used a descriptive qualitative approach. Data was collected using focus group discussions with professionals in the rehabilitation field. The recorded group discussions were transcribed verbatim, and content analysis was conducted. Results: Four focus group discussions were conducted. Four themes emerged from the analyses: patient-centred care, access to resources, promotion of health, and skilled healthcare workers. Conclusions: The suggested services and interventions needed to prevent secondary health conditions target the individuals with spinal cord injury (SCI), health providers, health systems care approach and other sectors outside the health system. These services and interventions will inform the development of a preventive care model.

A review of the framework and strategy for disability and rehabilitation services in South Africa.

Background: Rehabilitation is imperative for the successful integration of persons with disabilities into their social environments. The Framework and strategy for disability and rehabilitation services (FSDR) in South Africa, 2015-2020.was developed to strengthen access to rehabilitation services and ensure the inclusion of persons with disabilities in all aspects of community life. Despite the FSDR being commissioned, access to rehabilitation is a challenge for persons with disabilities and further compounded in rural communities. Objective: The study aimed to describe the barriers and facilitators that influenced the process of development, implementation and monitoring of the FSDR. Method: This qualitative study employed a single case study design. Data was collected through document analysis and in-depth interviews utilising the Walt & Gilson policy analysis framework that outlines the context, content, actors and process of policy development and implementation. In-depth interviews were conducted with twelve key informants (N=12) who were selected purposively for the study. Data obtained from the in-depth interviews were analysed using inductive thematic analysis. Results: We found many factors that influenced the implementation of the framework. Actor dynamics, insufficient resources, the rushed process, poor record-keeping, inappropriate leadership, negative attitudes of staff members and the insufficient monitoring impeded the successful implementation of the framework. While positive attitude, mentorship and support amongst the task team facilitated the implementation process, albeit with challenges. Conclusion: There is a need to address implementation gaps so that the FSDR is responsive to the current rehabilitation needs of persons with disabilities in South Africa. Contribution: This study may inform future disability policy, and can be used as a tool to advocate for the rights for persons with disabilities.

Environmental factors influencing the prevention of secondary health conditions among people with spinal cord injury, South Africa.

BACKGROUND: The environment where people live, work or play can influence health and disability outcomes. People with spinal cord injury are at risk for secondary health conditions, with this increasing readmission rates and decreasing quality of life. Studies on preventative care for secondary health conditions and factors influencing the prevention of secondary health conditions are scarce in low to middle-income countries. AIM: To explore environmental factors influencing the prevention of secondary health conditions in people with spinal cord injury. SETTING: This study was based at a public rehabilitation hospital, South Africa. METHODS: Explorative qualitative design was used. Semi-structured interviews were conducted with 21 therapists, 17 people with a spinal cord injury and six caregivers. The interviews were transcribed verbatim. Analysis was conducted using content analysis. RESULTS: The categories that emerged included the impact of social support, inaccessible built environment and transport system, and an inefficient health care system. Sub-categories for the inefficient health care systems were: Shortage of resources, health workers lack of knowledge on prevention of secondary health conditions and inadequate patient care approach. CONCLUSION: Environmental factors influencing the prevention of secondary health conditions are complex and multifactorial. When developing rehabilitation and prevention programmes, environmental factors must be considered.

Experiences of secondary health conditions amongst people with spinal cord injury in South Africa: A qualitative study.

BACKGROUND: Secondary health conditions (SHCs) such as pain, pressure sores, sexual problems, bowel and bladder problems are prevalent throughout the lifespan of people with spinal cord injury (SCI). Studies have reported that SHCs decrease life expectancy and increase health care costs. Studies on the lived experience of SHCs are, however, limited. OBJECTIVES: To explore the experiences of SHCs amongst people with SCI in a public rehabilitation hospital in South Africa. METHOD: Face-to-face semi-structured interviews were conducted with people with SCI from August 2018 to July 2019. All interviews were transcribed verbatim and analysed using a content analysis approach. RESULTS: Seventeen people with SCI were interviewed. Participants experienced a range of SHCs. The most common experienced SHC was pain (94%). The main theme that emerged from the analysis was 'the impact of secondary health conditions on health and well-being'. The categories linked to the impact were SHCs co-occurrence and how SHCs limit function, restrict participation, affect mental health and disrupt lives. CONCLUSION: We found that SHCs were enormously impactful on our participants' lives and health, as illustrated by their stories of fear, embarrassment and shame. Understanding people with SCI experiences of SHCs can enhance communication between people with SCI and health professionals and may help develop prevention strategies. CLINICAL IMPLICATIONS: To enhance patient-centred care, health professionals are encouraged to actively listen to patients' experiences of illness and the impact on health and wellbeing.

'I forget to do pressure relief': Personal factors influencing the prevention of secondary health conditions in people with spinal cord injury, South Africa.

BACKGROUND: Across the lifespan, people with spinal cord injury (SCI) may experience preventable secondary health conditions (SHCs) such as pressures sores, muscle spasms and urinary tract infections (UTIs). Some factors influencing prevention of SHCs include social support, poor access to care and the prevention style of individuals. There is limited research on these factors. OBJECTIVE: To explore personal factors influencing the prevention of SHCs in people with SCI. METHOD: An explorative qualitative study included participants recruited in an outpatient department at a rehabilitation hospital. Semi-structured interviews were conducted with patients with SCI. Interviews were transcribed verbatim. Data analysis was conducted using content analysis. RESULTS: Seventeen individuals with SCI were interviewed. From the interview analysis, six personal factors were identified, namely, socio-economic status; mental well-being (forgetfulness, beliefs, attitude); lack of knowledge of SHCs and prevention; lifestyle choices and practising prevention care; patient activation (self-management, problem-solving, resilience, self-awareness, help-seeking behaviour) and owning an appropriate assistive device. CONCLUSION: Socio-economic status, mental well-being, knowledge of SHCs and prevention care, behaviour patterns, patient activation and owning an appropriate assistive device can influence prevention of SHCs. To enhance patient-oriented care, a model of care for people with SCI should consider these factors when developing prevention strategies. Future research could look into identifying environmental factors that influence the prevention of SHCs in people with SCI. CLINICAL IMPLICATIONS: Tailored prevention strategies need to be developed, health professionals must ask patients about individual factors that may be barriers or facilitators to preventing secondary health conditions.

Prevention strategies for secondary health conditions in people with spinal cord injury: a scoping review protocol.

OBJECTIVE: The objective of the review is to map existing evidence and to provide an overview of the prevention strategies for secondary health conditions that have been reported in people with spinal cord injuries. INTRODUCTION: Spinal cord injury is a physical disability caused by a lesion in the spinal cord resulting in a loss of sensory and motor function below the affected area. In the lifespan of a person living with spinal cord injury, at least one preventable secondary health condition will develop. These conditions can be predictable and potentially prevented. INCLUSION CRITERIA: This review will consider studies that include participants 18 years and over with spinal cord injury and report on prevention strategies for secondary health conditions (e.g. pressure sores, urinary tract infection, pain) at all levels of disease prevention (primary, secondary and tertiary level). Studies of any design conducted in a clinical (hospital and primary healthcare facility), home or community-based setting will be considered. METHODS: A three-step search strategy will be used in this review, with an initial search of MEDLINE (PubMed) and CINAHL. Databases to be searched include: PubMed, PEDro, CINAHL, Embase, Scopus, Health Source: Nursing/Academic Edition and SPORTDiscus. Government resources (Department of Health website), World Health Organization, Google Scholar and OpenGrey will be searched for unpublished studies. Titles and abstracts will be screened by two independent reviewers. Studies that meet the inclusion criteria will be retrieved and assessed. Results will be presented in narrative and tabular form.

The value of a short practical training course for newly qualified therapists working with children with cerebral palsy in South Africa.

BACKGROUND: Cerebral palsy (CP) is the most common and most complex disabling disorder in children. Newly qualified therapists are expected to manage CP despite feeling inexperienced and inadequately prepared. Short postgraduate practical training courses could potentially help bridge this readiness gap. However, the value of these short courses in addressing the knowledge and experience gap is unknown. OBJECTIVES: To establish the value of a short practical training course on the self-perceived readiness of newly qualified South African trained therapists to work with children with CP. METHOD: Secondary analysis of records on therapists' immediate evaluation of a short practical training course on CP management was completed. The analysis included records from 11 courses collected over a 2-years period (2015-2017). Paired t-tests were used to determine the change in knowledge in the quantitative questionnaire. Qualitative data were analysed inductively to determine themes. RESULTS: The majority of therapists had their expectations met by the course. Therapists' self-perceived level of knowledge about various aspects of CP after the course changed significantly. Therapists appreciated the adult teaching and learning methods, conducive learning environment, the relevant and organised content and holistic approach of the course. They demonstrated readiness to adopt positive attitudes, perceptions and practice following the course. CONCLUSION: A short practical postgraduate training course in CP is valuable in addressing the self-perceived lack of readiness amongst therapists with little experience in this area. It is capable of improving the knowledge and changing attitudes, perceptions and practice intentions positively, and thereby potentially improving the quality of service offered to children with CP.

Prevention care for secondary health conditions among people living with spinal cord injuries: research protocol.

OBJECTIVE: People living with spinal cord injuries are at a high risk to experience preventable secondary health conditions in their lifetime, which can lead to rehospitalisation and death. Given the fact that spinal cord injury is a long term disability requiring on-going care, there is need to strengthen prevention of secondary health conditions. This study aims to establish factors influencing prevention care for secondary health conditions among people living with spinal cord injuries in a metropolitan area in order to develop a prevention model of care. RESULTS: A record review of patients living with spinal cord injuries will be conducted to identify the prevalence of secondary health conditions and associated factors. Semi-structured interviews will be conducted on patients living with spinal cord injuries, their caregivers and therapists to explore the contextual factors (personal and environmental factors) influencing the prevention of secondary health conditions. Thematic analysis will be used to identify the themes. Nominal group technique will be used to develop the prevention model of care for secondary health conditions. This study will be conducted at a tertiary and specialised rehabilitation hospital in South Africa.

University of the Witwatersrand physiotherapy undergraduate curriculum alignment to medical conditions of patients within Gauteng state health facilities.

BACKGROUND: The healthcare sector requires graduates with the ability to confidently assess and manage the majority of the medical conditions seen in hospitals. OBJECTIVE: To establish whether the most prevalent medical conditions treated by physiotherapists in Gauteng (South Africa) state health facilities align with the University of the Witwatersrand (Wits) physiotherapy curriculum. METHODS: This was a retrospective review of condition-related statistics from physiotherapy departments within the Gauteng province state health facilities. Data from all Gauteng government hospitals that had submitted at least 75% of their physiotherapy condition-related statistics to the provincial statistics coordinator from January 2012 to December 2014 were considered and compared to medical conditions covered in the Wits 2015 physiotherapy curriculum to check if all conditions listed in the Gauteng statistics appeared within the Wits curriculum document. The number of teaching hours for the common conditions was noted to check the emphasis given to these conditions in the curriculum. RESULTS: Eighty-three per cent of the hospitals submitted 75% of their monthly statistics. Overall, the most common conditions treated were lower limb fractures (13%) followed by stroke (7.6%) (n = 705 597). Within the neuro-musculoskeletal category, the most common conditions after lower limb fractures were soft tissue injuries (15.1%) (n = 330 511). The most common cardiopulmonary conditions were tuberculosis (24.9%), followed by pneumonia (13.8%) (n = 94 895). The most common neurological conditions were stroke (30.9%) followed by cerebral palsy (17%) (n = 174 024). Within the non-specified categories, the number of intensive care unit (ICU) patients was the highest (23%), followed by sputum induction (21%) (n = 138 187). The most common conditions that were emphasised within the Wits curriculum as indicated by the teaching hours: fractures, 14.5 (66%) of 22 third-year orthopaedics hours; stroke, 30 (73%) of 41 third-year neurology hours; soft tissue injuries, 18 (38%) of 48 fourth-year neuro-musculoskeletal hours; back lesions, 24 (50%) of 48 fourth-year neuro-musculoskeletal hours; and ICU patients, 30 (79%) of 38 fourth-year cardiopulmonary hours. CONCLUSION: The Wits physiotherapy curriculum covers all medical conditions treated by physiotherapists within the Gauteng state health facilities, and overall, the curriculum prepares the students to practise in a variety of situations.