Conceptualisation of community-based rehabilitation in Southern Africa: A systematic review.

BACKGROUND: Community-Based Rehabilitation (CBR) has evolved over the last 30 years and now focuses on empowering persons with disabilities to access and benefit from a wide range of services. The evidence for CBR is frequently cited in the literature as being scanty and of poor quality. PURPOSE: We sought to determine how CBR is conceptualised and understood in the literature from Southern Africa. Our interest centred on to what extent the literature could inform policy makers and practitioners in the region. METHODS: A systematic review of the literature from countries in Southern Africa guided by Population, Intervention/Phenomenon of Interest, Context and Outcome of Interest to the reviewer (PICO) was employed. This involved an extensive, internally valid and systematic search of electronic databases using specific keywords/subject heading combinations. Journal articles reporting on a description or objectives of CBR, published after 2006, and journal articles written in English of all types of studies were included. Data were charted according to the emergent themes. Two independent raters coded the emergent themes. RESULTS: Nine from a possible 257 published articles were reviewed; four of these were programme evaluations. Themes describing CBR converged on community development and poverty reduction. Only one article referred to human rights. Training and supervision of CBR workers and education of the community about disability were frequently reported activities. CONCLUSION: In isolated cases, the literature is aligned to components of the CBR matrix. However, consistent with previous criticism of CBR, the literature is meagre, as is the evidence to inform policy makers and practitioners in southern Africa.

The Second Physical Therapy Summit on Global Health: developing an action plan to promote health in daily practice and reduce the burden of non-communicable diseases.

Based on indicators that emerged from The First Physical Therapy Summit on Global Health (2007), the Second Summit (2011) identified themes to inform a global physical therapy action plan to integrate health promotion into practice across the World Confederation for Physical Therapy (WCPT) regions. Working questions were: (1) how well is health promotion implemented within physical therapy practice; and (2) how might this be improved across five target audiences (i.e. physical therapist practitioners, educators, researchers, professional body representatives, and government liaisons/consultants). In structured facilitated sessions, Summit representatives (n = 32) discussed: (1) within WCPT regions, what is working and the challenges; and (2) across WCPT regions, what are potential directions using World Café(TM) methodology. Commonalities outweighed differences with respect to strategies to advance health-focused physical therapy as a clinical competency across regions and within target audiences. Participants agreed that health-focused practice is a professional priority, and a strategic action plan was needed to develop it as a clinical competency. The action plan and recommendations largely paralleled the principles and objectives of the World Health Organization's non-communicable diseases action plan. A third Summit planned for 2015 will provide a mechanism for follow-up to evaluate progress in integrating health-focused physical therapy within the profession.

The emerging pattern of disability in Rwanda.

PURPOSE: The purpose of this paper is to describe the emerging pattern of disability (activity limitation) in terms of its prevalence, age and gender distribution in Rwanda. METHOD: A door-to-door survey was conducted in all households in villages from two districts selected through a multi-stage sampling procedure. Identified persons were screened for activity limitations using age-appropriate instruments developed from domains in the ICF. Proportions were computed and disaggregated by age group, gender, district and activity limitation. A multi-disciplinary rehabilitation team including community members participated in the development of instruments, community mobilisation, data collection and collation. RESULTS: Prevalence rates of 8.6% (Bugesera) and 14.7% (Musanze) were obtained. The prevalence of disability was higher in adults than in children in both districts (10.4% versus 6.6% in Bugesera and 19.6% versus 7.7% in Musanze). Visual limitations occurred the most frequently in both adults and children in both districts. Mobility and mental health limitations also notably contributed to the overall disability burden. CONCLUSION: The prevalence of disability obtained was higher than all previously reported data for Rwanda. Despite the limitations, the findings provide useful information for planning rehabilitation services and to direct future enquiry into the epidemiology of disability in Rwanda. Implications for Rehabilitation It is important to design specific surveys to measure disability using contemporary methods to gauge the situation accurately and qualitatively. Currently, the ICF provides the best framework to describe the epidemiology of disability meaningfully; it enables comparisons within and between countries and regions of the world; and enables the active participation of a wide range of rehabilitation stakeholders including PWDs and lay community members. The vast majority of disabilities in Rwanda are limitations in visual, mobility and mental health functions.

Retrieving physiotherapy patient records in selected health care facilities in South Africa--is record keeping compromised?

PURPOSE: The purpose of this study was to evaluate the process and feasibility of retrieving patient records in a variety of physiotherapy care settings in the Gauteng province in the Republic of South Africa. METHODS: Thirteen public and private health care facilities providing physiotherapy services were studied. Multiple methods of data collection (facility walk-through observation aided by a researcher designed checklist, in-depth interviews and attempting to retrieve physiotherapy records) were employed to evaluate the process of retrieving physiotherapy patient records, determine physiotherapy record retrieval rates and to determine the factors that were influencing record retrieval. RESULTS: The process of retrieving physiotherapy records was arduous and multi-faceted, with some health care facilities allowing patients to take their records home. A final retrieval rate of 46% (36.3% - 100%) was obtained. An odds ratio calculation revealed that it was 13.09 (CI: 8.99 - 19.13; p<0.001) times more possible to retrieve records of patients treated in private physiotherapy care settings (87.4% retrieval rate) than in public sector physiotherapy care settings (34.67% retrieval rate). CONCLUSIONS: This study concludes that the process of retrieving physiotherapy records was arduous and lacked uniformity in public sector hospitals. Further a low physiotherapy record retrieval rate was obtained.