A scoping review of prehabilitation interventions for arthroplasty patients.

Background: Osteoarthritis (OA) is a long-term condition that causes significant impairment, and because of the increasing prevalence of OA, the demand for arthroplasty will continue to rise. However, the demand will not be matched by availability, because of prioritisation of trauma-related surgeries. Implementing prehabilitation could assist physiotherapists in having an impact on improving access by reducing the length of stay. Objectives: The aim of our scoping review was to explore, map and identify trends and gaps to better inform the content of a prehabilitation programme. Method: In our scoping review, studies between 1995 and 2020 were identified and included based on inclusion and exclusion criteria and study methodology described by Arksey and O'Malley. The results were collated and summarised as a narrative synthesis. Results: A total of 200 articles were identified and exported from four databases of which 48 articles were included in the final analysis. Regarding the efficacy of prehabilitation interventions, 21 studies reported significant results supporting prehabilitation, whereas 11 studies reported non-significant results. Conclusions: Prehabilitation could be a valuable adjunct in reducing length of hospital stay and improving functional outcomes in adults undergoing total joint replacement. Clinical implications: The scoping review described the information available on prehabilitation in lower limb arthroplasty patients and could potentially inform the design of a prehabilitation programme suitable for use in the South African public health context.

Challenging power and unearned privilege in physiotherapy: lessons from Africa.

Power and unearned privilege in the profession of physiotherapy (PT) reside in the white, Western, English-speaking world. Globally, rehabilitation curricula and practices are derived primarily from European epistemologies. African philosophies, thinkers, writers and ways of healing are not practiced widely in healthcare throughout the globe. In this invited perspectives paper, we discuss the philosophies of Ubuntu and Seriti, and describe how these ways of thinking, knowing, and being challenge Western biomedical approaches to healthcare. We believe implementing these philosophies in the West will assist patients in attaining the health outcomes they seek. Further we call for Western professionals and researchers to stand in solidarity with their African counterparts in order to move towards a diversity of practitioners and practices that help to ensure better outcomes for all.

Perceptions of women enrolled in a cardiovascular disease screening and prevention in HIV study.

BACKGROUND: The ISCHeMiA (integration of cardiovascular disease screening and prevention in the human immunodeficiency virus [HIV] management plan for women of reproductive age) study is an ongoing, 3-year, prospective, quasi-experimental study comparing usual care to a primary health care intervention plan guided by the World Health Organization Package of Essential Non-Communicable (WHO-PEN) disease interventions. Sixty eight percent of women were overweight or obese at baseline in the ISCHeMiA study, many of whom reported nonadherence to interventions at 6 months post enrolment. This study explores the perceptions of women living with HIV (WHIV) towards their participation in the ISCHeMiA study to understand the barriers and facilitators to lifestyle modification interventions for cardiovascular disease (CVD) risk prevention. METHODS: A qualitative enquiry using semistructured interviews was conducted with 30 overweight WHIV at one year post-enrolment in the WHO-PEN intervention arm of the ISCHeMiA study. Data were transcribed verbatim following the interviews and analysed using conventional content analysis. RESULTS: Four major themes emerged from the data, namely perceived body image, benefits barriers and recommendations to improve adherence to WHO-PEN lifestyle modification management. CONCLUSION: Women in the ISCHeMiA study believed that HIV associated stigma hindered access to care. Financial limitations and the lack of social support posed barriers to adherence to programme participation. They were further challenged by poor body image perception. Participants believed that such interventions offered them hope and feelings of improved well-being. Women recommended that lifestyle modification interventions such as those studied in the ISCHeMiA study should include partners and family to improve adherence through social support.

Scoping review protocol of prehabilitation interventions for primary arthroplasty.

Background: Osteoarthritis (OA) ranks fifth among all forms of disability worldwide and primary replacement arthroplasty is the treatment of choice in late-stage OA. The current situation in South Africa is that the waiting lists for arthroplasty are extensive with steep costs. According to many studies, physiotherapists can have an impact on this situation by implementing prehabilitation. Objectives: The aim of our study is to identify the trends in the literature regarding the content of prehabilitation programmes as well as the gaps. Method: The methodology will involve a literature search and the methodology as proposed by the Joanna Briggs Institute guidelines. The literature searches will be conducted in electronic databases and peer-reviewed journal studies will be included based on predetermined inclusion criteria. Two reviewers will screen all citations and full-text articles and the first author will abstract the data. Results: The results will be organised into themes and sub-themes, summarised, and reported as a narrative synthesis. Conclusion: The proposed scoping review will map the breadth of knowledge available on the topic of prehabilitation in terms of exercise prescription principles, pre-operative optimisation and gaps. Clinical implications: This scoping review is the first part of a study that aims to design a prehabilitation programme suitable for the South African public health user as the demographic and physical characteristics of its health users are unique and dependent on the context.

Engaging Ethnically Diverse Populations in Self-Management Interventions for Chronic Respiratory Diseases: A Narrative Review.

The burden of chronic respiratory diseases continues to rise globally. Comprehensive management relies on a combination of treatment approaches including patient self-management, where health professionals are required to educate and support patients to take control of their disease. When self-management interventions are suitably directed and effectively executed, outcomes point to increases in quality of life and a reduction in unscheduled or emergency consultations for people living with chronic respiratory disease. However, despite these positive gains, the literature reveals poor trends of engagement with this management approach and reduced access to appropriately designed programs for people from ethnically diverse populations, including migrants and refugees. The purpose of this review article is to discuss factors influencing engagement in chronic respiratory disease self-management among people from ethnically diverse backgrounds and to propose strategies to improve the participation of this population in these interventions in the future.

Erratum: Burden of caring for children living with human immunodeficiency virus in a semi-rural South African community.

No abstract available.

Pre-operative physiotherapy following unilateral ankle fractures at a tertiary hospital in South Africa: Perceptions of patients and nurses.

BACKGROUND: Ankle fractures are a common injury because of an increase in levels of physical activity, as well as senescence worldwide. Ankle fractures often require surgical management for optimal stabilisation. Pre-operative physiotherapy is necessary to prepare patients for early mobilisation and home discharge. There is a lack of information on the influence of pre-operative physiotherapy on post-operative rehabilitation success, as well as timeous discharge, in patients with ankle fractures. OBJECTIVES: To explore the perceptions of patients receiving pre-operative physiotherapy care following a unilateral ankle fracture and the perceptions of nursing staff managing these patients at a tertiary hospital in South Africa. METHOD: A descriptive qualitative design, using semi-structured interviews, including both patients with unilateral ankle fractures and nurses caring for these patients, was adopted. Interviews were recorded and verbatim transcriptions were analysed utilising thematic analysis. RESULTS: Four overarching themes emerged: the perceived benefits of pre-operative physiotherapy; inhibitors to physiotherapy rehabilitation; hidden enablers to pre-operative physiotherapy and future initiatives for rehabilitation. CONCLUSION: The perceived benefits included improved functional independence and safety of patients, as well as reduced burden of care for nurses. Patients also believed that pain and fear were two inhibitors to physiotherapy. Furthermore, nurses identified that organisational limitations, such as short-staffing and inadequately trained staff, inhibited pre-operative physiotherapy and continuity of care. Early post-operative discharge was a crucial hidden enabler to the pre-operative physiotherapy protocol. Recommendations included improved health education; the potential role of nursing staff as facilitators in pre-operative rehabilitation and regular, pre-operative in-patient monitoring of physiotherapy intervention. CLINICAL IMPLICATIONS: Health education was perceived to have improved patient safety and compliance which subsequently reduced patient safety incidences as well as served as a risk mitigation measure. Furthermore, gait training and muscle strengthening exercises was perceived to have resulted in safe, independent mobility to ensure prompt discharge home. Consequently, a reduced post-operative length of in hospital stay results in major cost savings per patient as well as improved access and bed availability. Future studies may need to explore the effects of pre-operative physiotherapy on post-operative success and return to pre-injury activity.

HIV-related disability and rehabilitation: perception of health care workers.

Background: Health care workers play an integral role in the rehabilitation and care of people living with HIV who face multiple impairments and often disabilities. The aim of the article was to understand the perceptions and attitudes of health care workers towards caring for people living with HIV, and experiencing disability. Methods: Fifteen health care workers offering care to people living with HIV were interviewed using a semi-structured guide. These health care workers included doctors, a social worker, a pharmacist, a dietician, an occupational therapist, a physiotherapist, and nurses and HIV couPnsellors who were employed at a public health care facility in KwaZulu-Natal. Data from the interviews were transcribed and analysed using conventional content analysis. Results: Four themes emerged from semi-structured interviews with the health care workers: a holistic disability framework, a multidisciplinary team dynamic, organisational barriers and recommendations by health care workers. Conclusion: Health care workers perceived a shift from a biomedical perspective of disability to a bio-psychosocial interpretation that is influenced by contextual and environmental barriers imposed by communities on people living with HIV. Barriers included stigmatisation that leads to attitudinal barriers and social exclusion of people living with HIV and experiencing disabilities within communities. Lack of resources, including of equipment, and a shortage of health care staff also posed barriers to the care offered to people living with HIV and experiencing disabilities. Participants agreed that improved communication in the multidisciplinary health care team, as well as continuing education and training, would enable health care workers to offer improved, integrated care to people living with HIV who experience disabilities.

Child functioning and disability in children living with human immunodeficiency virus in a semi-rural healthcare setting in South Africa.

BACKGROUND: Children living with HIV (CLHIV) often experience HIV-related impairment and disability. AIM: The study sought to understand the level of child functioning and access to rehabilitative care in the context of South African healthcare in order to inform an integrated rehabilitative framework. SETTING: District level semi-rural healthcare facility in KwaZulu-Natal. METHODS: The Washington Group/United Nations International Children's Emergency Fund Module on Child Functioning, was administered to carers of CLHIV aged between 5 and 10 years, and accessing care at the study setting. RESULTS: Forty-four caregivers of children receiving treatment from June 2018 to March 2019, at the facility, participated. Four (9.1%) children had difficulty with seeing, 13 (29.5%) children had difficulty with hearing and 10 (22.7%) children had difficulty with walking. In the cognitive and behavioural domains, 17 (38.6%) children reported difficulties in communication and concentration, with 16 (36.4%) children experiencing difficulties in learning and remembering. Difficulties reported in accepting change and controlling behaviour were both experienced by 23 (52.3%) children. Although many children experiencing impairments were referred for rehabilitation, many caregivers did not follow-up after the initial assessment, because of financial constraints, lack of time and transport restrictions. CONCLUSION: Functional difficulties were frequently experienced by children living with HIV. Disability screening would be beneficial at various points of care to promote early identification and timely referral to healthcare professionals. Decentralising rehabilitative care to homes and communities could offer a solution to some of the reported barriers to accessing care.

Schooling for children living with human immunodeficiency virus in a community in KwaZulu-Natal, South Africa: Perceptions of educators and healthcare workers.

BACKGROUND: Children living with human immunodeficiency virus (HIV) are faced with challenges, such as social and contextual barriers in society, resulting from their disabilities. Schooling and education, which are crucial for children's future livelihoods, are areas in which children living with HIV often experience exclusion within South African communities. Educators and healthcare professionals, through collaborative efforts, could influence schooling by improving access and care for children living with HIV. OBJECTIVES: To explore the perceptions of educators and healthcare workers on schooling for children living with HIV in a semi-rural community in South Africa. METHODS: Semi-structured interviews were held, with eight healthcare workers and eight educators, adopting an explorative qualitative approach. Data from the interviews were transcribed and analysed using content analysis. RESULTS: Four overarching themes were identified: the influence of living with HIV on school readiness and progression; stakeholder support practices to enhance bonding and bridging; obstacles to support; and future directives to foster success at school for children living with HIV. CONCLUSION: Educators and healthcare workers felt that social determinants, including poverty and stigma, as well as comorbidities of the virus, influenced the school readiness of children living with HIV. Bonding with children and partnering with caregivers was seen as crucial for fostering successful schooling. CLINICAL IMPLICATIONS: Additionally, interdisciplinary collaboration between healthcare workers and educators was seen as important for a holistic approach to caring for children living with HIV. Early identification of disabilities was also believed to be important in addressing the social barriers hindering schooling.

Burden of caring for children living with human immunodeficiency virus in a semi-rural South African community.

BACKGROUND: Caregiver burden influences the well-being of children living with human immunodeficiency virus (HIV) who may experience disabilities as a result of the virus, comorbidities and treatment. Overall health, psychological well-being, finances, social life and the relationship with the child being cared for influence the burden of care. This study aimed to investigate the burden of care on caregivers of children living with HIV who may be experiencing disabilities. METHODS: An analytical cross-sectional survey using the Zarit Burden questionnaire was conducted with caregivers of children living with HIV who were accessing care from a semi-rural healthcare setting between May and August 2019. A socio-demographic survey supplemented the Zarit Burden instrument. Descriptive statistics were used to determine burden of care and associations between the demographic profile variables of caregivers and the burden of care, with significance set as p 0.05. RESULTS: Thirty-eight caregivers completed the survey. Although 44.7% reported no burden of care, 36.8% reported mild-to-moderate burden and 18.4% moderate-to-severe burden of caring for children living with HIV. The only significant association was between caregiver health status and burden of care (p = 0.034). CONCLUSION: Although the burden of care in caregivers ranged between mild to severe and was directly associated with the caregiver's health status, the findings of this study highlight a need to assess caregiver burden in all caregivers of children living with HIV so that appropriate referral to professionals for counselling and support can be initiated. Because caregiver burden affects the care offered to children, professionals need to integrate their well-being into healthcare.

Children living with HIV-related disabilities in a resource-poor community in South Africa: caregiver perceptions of caring and rehabilitation.

The care offered to children living with HIV (CLHIV) experiencing HIV-related disability is often challenged by caregiver illness, poverty and poor support structures in and around communities. Since caregiver needs directly influences the care offered to CLHIV this paper aimed to explore the experiences of the caregivers of CLHIV in order to inform an appropriate rehabilitation model in South Africa. A qualitative enquiry using in-depth interviews with 14 caregivers (one male and thirteen females) of CLHIV experiencing disability in a peri-urban setting was conducted. Data were analysed using thematic analysis. Four themes emerged from the interviews: understanding of HIV-related disability and rehabilitation, challengers to care and well-being, enablers to care; and perceived needs of caregivers. The study revealed that caregiver burden is influenced by the availability of resources and social support services. Financial constraints, poor access to rehabilitation and reduced support networks challenged the care offered to CLHIV. The perceived needs of the caregivers in this study included appeals for improved social security, housing, accessible rehabilitation and education. Changes in government policy guiding social support, employment, education and rehabilitation interventions are needed to improve the availability of resources, education, health and well-being of CLHIV and their caregiver's in South Africa.

A Rehabilitation Framework for Children Living With HIV in South Africa: Reaching Consensus for a Resource-Poor Community.

Although rehabilitation frameworks for adults living with HIV are developing steadily, interventions to ensure the integration of rehabilitation into the routine care of children living with HIV-related disabilities lags. We sought to explore perceptions of, and gain expert consensus on, a rehabilitation framework for children living with HIV. Experts in HIV pediatric care in South Africa engaged in a Delphi survey, based on findings from a context-specific rehabilitation framework for adults. Consensus was determined by an a priori threshold of 80% agreement and an interquartile range of 1 or lower on criteria to be included as essential or useful in the framework. Experts agreed that enhancing access to patient-centered care through decentralization and training of health care and community care workers in the use of disability screening tools at each point of care needed to be included in the framework. Strengthening multiprofessional team collaboration was also seen as fundamental.

Child functioning and disability in children living with human immunodeficiency virus in a semi-rural healthcare setting in South Africa

Background: Children living with HIV (CLHIV) often experience HIV-related impairment and disability. Aim: The study sought to understand the level of child functioning and access to rehabilitative care in the context of South African healthcare in order to inform an integrated rehabilitative framework. Setting: District level semi-rural healthcare facility in KwaZulu-Natal. Methods: The Washington Group/United Nations International Children's Emergency Fund Module on Child Functioning, was administered to carers of CLHIV aged between 5 and 10 years, and accessing care at the study setting. Results: Forty-four caregivers of children receiving treatment from June 2018 to March 2019, at the facility, participated. Four (9.1%) children had difficulty with seeing, 13 (29.5%) children had difficulty with hearing and 10 (22.7%) children had difficulty with walking. In the cognitive and behavioural domains, 17 (38.6%) children reported difficulties in communication and concentration, with 16 (36.4%) children experiencing difficulties in learning and remembering. Difficulties reported in accepting change and controlling behaviour were both experienced by 23 (52.3%) children. Although many children experiencing impairments were referred for rehabilitation, many caregivers did not follow-up after the initial assessment, because of financial constraints, lack of time and transport restrictions. Conclusion: Functional difficulties were frequently experienced by children living with HIV. Disability screening would be beneficial at various points of care to promote early identification and timely referral to healthcare professionals. Decentralising rehabilitative care to homes and communities could offer a solution to some of the reported barriers to accessing care

Rehabilitation approaches for children living with HIV in sub-Saharan Africa: a protocol for scoping review.

BACKGROUND: A large number of children living with chronic conditions such as HIV experience impairments and disabilities. Current sub-Saharan African healthcare systems are challenged with paediatric care that does not integrate rehabilitation into management of chronic diseases such as HIV. Furthermore, little attention is paid to societal inclusion, community engagement and educational needs of these children. Integration of paediatric care and rehabilitation in a holistic approach can help to overcome the challenges associated with living disabilities. This scoping review proposes a synthesis of existing evidence on rehabilitation intervention strategies to increase functioning and to address disability-related barriers in children living with HIV and disability in sub-Saharan Africa. METHODS: A scoping review will be conducted to systematically map evidence on rehabilitation intervention for children living with HIV in sub-Saharan Africa. Studies in sub-Saharan Africa from December 2012 to 2019 on rehabilitation interventions for children aged 5 to 10 years living with HIV will be included in the review. Peer-reviewed primary studies, as well as grey literature, will be identified from electronic databases including Google Scholar; PubMed; Medline; CINAHL and Cochrane. The search strings using keywords such as "HIV", "impairment", "disability", "neurocognitive impairment", "behavioural", "rehabilitation" and "intervention" will be conducted using Boolean logic. Two groups of independent reviewers will conduct all title, abstract and full article screening. The study selection process will be mapped using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. A predesigned data-charting table will supplement the extraction of data. NVIVO software will aide in the thematic analysis of the data. DISCUSSION: The information from studies will be discussed in relation to the research questions using a critical narrative to explore the emergent themes. The quality of studies will be appraised using the mixed method appraisal tool. The scoping review will provide a baseline of evidence on rehabilitation interventions for children living with HIV in sub-Saharan Africa. The scoping review will inform healthcare providers, scholars and policy developers about the current use of rehabilitation interventions and what gaps need to be addressed with further research and intervention development. SYSTEMATIC REVIEW REGISTRATION: OSF Center for Open Science: https://osf.io/ed7zb/.

Community-based primary healthcare training for physiotherapy: Students' perceptions of a learning platform.

BACKGROUND: South Africa is faced with an overburdened public healthcare system and physiotherapists need to be equipped to address these challenges. Community-based primary healthcare clinical training (CBPHCT) offers physiotherapy students with learning opportunities to develop core competencies in order to address the needs of a disparate healthcare system. OBJECTIVES: To explore the experiences of physiotherapy students participating in a CBPHCT platform. METHOD: An explorative qualitative approach was adopted, using focus group discussions with final year physiotherapy students exposed to a year of CBPHCT. Data from the focus groups were transcribed and analysed using content analysis. RESULTS: Four overarching themes were identified: prerequisite community-based primary healthcare competencies, positive factors associated with CBPHCT, negative factors associated with CBPHCT and recommendations. CONCLUSION: The CBPHCT experience was seen to present challenges to, and have benefits for, physiotherapy students. The students felt that communication between stakeholders, such as academic staff and hospital personnel, could be developed, while the lack of resources, such as Internet access, posed a barrier to learning. Students felt core competencies, such as professionalism of caring, were influenced by their exposure to the clinical personnel. Furthermore, they saw themselves as health advocates and felt there was mutual benefit from engagement with communities during their clinical placements. Recommendations included a review of physiotherapy curricula to prepare students for CBPHCT. CLINICAL IMPLICATIONS: Community-based primary healthcare clinical training provides learning opportunities for undergraduate physiotherapy students to develop core competencies, such as health advocacy, necessary to address the unique needs of a disparate South African healthcare system.

A study protocol "saving futures: developing an integrated model of rehabilitation and paediatric HIV care to foster success at school".

BACKGROUND: A significant number of children experience disabilities as a result of living with HIV, including those on antiretroviral therapy (ART). Current paediatric HIV care does not prioritise rehabilitation. Furthermore, little attention is paid to cognitive development and educational needs, thereby placing the future of these children at risk. This can be mitigated by providing rehabilitation services to help overcome these disabilities. METHODS: The study will assess the feasibility (acceptability, practicality, preliminary efficacy) of an integrated model of rehabilitation and paediatric HIV care in order to improve diagnosis and interventions for disability amongst children living with HIV between the ages of 5 and 10 years. The model will integrate data entry and management tools, improving identification, referral, and linkage to care, with an intervention approach that can be used by trained lay health professionals. The study targets both physical and cognitive impairments that lead to disabilities to improve school readiness and success. Phase 1 will inform the design of an optimal integrated model of rehabilitation and paediatric HIV care in a public healthcare setting in South Africa. The study will first undertake a formative investigation of the factors impacting integration of rehabilitation with paediatric HIV care from the perspective of caregivers and health professionals. It will use qualitative methods, including in-depth interviews and focus group discussions. The knowledge from this phase will inform the design of the model in phase 2, and phase 3 will pilot the integrated rehabilitation and paediatric HIV model with the aim to improve school readiness for the participants at the study site. The pilot intervention will be formally evaluated. DISCUSSION: The results from this study will determine whether the model has potential for widespread application in South African paediatric HIV care and recommend further possible modifications. This will inform the development of a proposal to support the current government initiative to strengthen disability and rehabilitation services. The study results will also inform South Africa's current efforts to strengthen early interventions for children with disabilities and will be an important and critically needed step in the use of rehabilitation to strengthen paediatric HIV care in the region.

Patients' Experiences of and Perspectives on Phase 1 Cardiac Rehabilitation after Coronary Artery Bypass Graft Surgery.

Purpose: This study explored and described patients' experiences and perceptions of phase 1 cardiac rehabilitation (CR) after a coronary artery bypass graft (CABG) at a public hospital in the province of KwaZulu-Natal, South Africa. CR is recognized around the world as an effective means of preventing disability and prolonging life in post-CABG patients. Despite this, participation in CR is low. Furthermore, little is known about patients' perceptions of CR programmes in South Africa. Method: We used a descriptive qualitative study design to study nine purposively selected participants (mean age 56 y) who had received only individualized CR post-CABG or individualized CR in combination with group CR exercise. The participants were organized into focus groups of attenders and non-attenders of the group CR exercise classes. The four attenders were all men, and the non-attenders were three men and two women. Interviews were transcribed verbatim and subjected to thematic analysis. Results: The three main themes that emerged were communication challenges between health care professionals and patients, the patients' experience of physiotherapy, and their recommendations for service delivery. Conclusion: Patients' perceptions of the current delivery of phase 1 CR in this study setting emphasized that improvements need to be made in the areas of patient-centred care, equality of access to programmes, and appropriateness of programme content. The results appear to indicate that patients have a limited awareness of and participation in in-patient and outpatient CR programmes. Research into improving the design of CR programmes in South Africa is required, in consultation with patients and the multidisciplinary health care team.

Objectif : explorer les perceptions des patients après un pontage aortocoronarien de la phase 1 du programme de réadaptation cardiaque (RC) dans un hôpital public de la province du KwaZulu-Natal en Afrique du Sud. La RC est reconnue dans le monde comme un moyen efficace de prévenir l'invalidité et de prolonger l'espérance de vie des patients ayant subi un pontage aortocoronarien. Or, le taux de participation au programme de RC est faible. De plus, on ne sait pas grand-chose des points de vue des patients sur les programmes de RC en Afrique du Sud. Méthodologie : l'étude qualitative et descriptive a été menée auprès de neuf patients choisis expressément (âge moyen : 56 ans) qui avaient participé à un programme de RC individuel seulement après leur pontage aortocoronarien ou à un programme individuel ainsi qu'à des exercices de RC de groupe. Les participants ont été séparés en deux groupes de discussion selon qu'ils avaient participé ou non aux cours de RC de groupe. Les quatre participants aux cours de groupe étaient des hommes, alors que l'autre groupe comptait trois hommes et deux femmes. Les entrevues ont été transcrites textuellement et ont fait l'objet d'analyse thématique. Résultats : les trois principaux thèmes dégagés sont les défis de communication entre les professionnels de la santé et les patients, l'expérience des patients en physiothérapie et leurs recommandations concernant la prestation des services. Conclusion : les perceptions des patients mettent en relief un besoin d'amélioration en ce qui a trait aux soins axés sur le patient, à l'équité d'accès aux programmes et à la pertinence du contenu. Les résultats donnent à croire que les patients ont une connaissance limitée des programmes de RC offerts à l'hôpital et en milieu ambulatoire et y participent peu. Il faudrait approfondir les recherches en vue d'améliorer la conception des programmes de RC en Afrique du Sud en consultation avec les patients et les équipes de soins multidisciplinaires.

Physiotherapy postgraduate studies in South Africa: Facilitators and barriers.

AIM: To investigate the facilitators and barriers to attaining a postgraduate physiotherapy degree in South Africa. METHODS: A quantitative, cross-sectional design using an internet-based survey was employed. The population of the study included all qualified physiotherapists who had completed community service and who were on the South African Society of Physiotherapy e-mailing list at the time of the study. RESULTS: In all, 425 valid responses were received. The study participants were predominantly white women with a mean age of 36.9 and the majority were working in private practice. A total of 20.5% of respondents had completed a master's or doctoral degree in physiotherapy, while a further 13% of respondents were registered for a postgraduate degree in physiotherapy at the time of the study. Study participants who had obtained a postgraduate degree identified the same main barriers (namely cost/lack of financial support, family commitments and lack of time) and the same main facilitators (namely gaining of expertise, fulfilment of a personal goal and improvement of patient care) as participants who had not obtained a postgraduate degree. Participants who had not obtained a postgraduate degree were significantly more likely (p < 0.05) to report concerns regarding their own ability and a lack of motivation as barriers to further study. CONCLUSION: South African physiotherapists with and without a postgraduate degree reported common facilitators and barriers to pursuing postgraduate studies. In order to ensure that a greater number and diversity of physiotherapists see postgraduate studies as a worthwhile career option, stakeholders in health and education in both the South African public and private sectors need to be engaged to limit the barriers to postgraduate study and seek novel methods of making postgraduate study a more attractive option from a personal development and career perspective.