Factors influencing survival outcomes in patients with stroke in Zimbabwe: A 12-month longitudinal study.

Background: In this longitudinal study, we aimed to determine factors influencing survival outcomes among patients with stroke over a 12-month period. The investigation sought to uncover influential determinants to enhance the precision of prognostic assessments and inform targeted interventions for individuals affected by strokes. Methods: Employing a longitudinal study design, participants were observed for 12 months from baseline, censoring survivors at the endpoint. The dataset originated from a comprehensive study involving stroke patients treated at three referral hospitals in Zimbabwe: Parirenyatwa, Sally Mugabe, and Chitungwiza Central Hospital. The primary outcome variable, the duration of survival until death, was measured in days from the initiation of stroke treatment. Gompertz parametric regression analysis was utilized for data modeling following Accelerated Failure Time (AFT) model diagnostics. Results: In our study, 188 stroke patients were enrolled at baseline. However, 51 patients were excluded from the analysis due to either missing information or loss to follow-up. Among the remaining 137 patients who were tracked over a 12-month period, 42% were censored, and 58% were deceased. Individuals utilizing 'Free Service (older than 65/pensioners/retirees)' hospital bill payment methods showed a decreased risk of death (HR: 0.4, 95% CI: 0.20, 0.80), suggesting a protective effect compared to cash paying patients. Those with a secondary school level education displayed a significantly lower risk of death (HR: 0.2, 95% CI: 0.04, 0.69) compared to those without formal education. Age was a significant factor, with individuals aged 45-65 and those over 65 years showing higher adjusted hazard ratios (HR: 4.9, 95% CI: 1.80, 13.25; HR: 5.5, 95% CI: 1.92, 15.95, respectively) relative to those below 45 years of age. Housing status revealed a protective effect for those residing with parents/relatives (adjusted HR: 0.4, 95% CI: 0.20, 0.66), while individuals with a 'Very severe' functional outcome showed an increased hazard (adjusted HR: 4.9, 95% CI: 1.12, 21.33). Conclusion: The study findings demonstrate that hospital bill payment methods, housing status, educational attainment, functional outcome, and age significantly affect survival outcomes among stroke patients. This highlights the need to consider socio-demographic and clinical variables in the development of prognostic assessments and targeted interventions for individuals recovering from stroke.

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.

The development of items for a physiotherapy clinical programme evaluation tool.

Background: Evaluating a physiotherapy clinical education programme is challenging, given its complex and multidimensional nature, resulting in a paucity of research on the topic. Objectives: The objective of our study, which was part of a larger study, was to identify items that could be included in a tool to evaluate a physiotherapy clinical education programme in South Africa. Method: A qualitative study utilising focused group discussions including academics, clinical educators and clinicians was undertaken. A broad script that delved into clinical education experience was used. An inductive thematic content analysis using MaxQda version 2018.2 was undertaken; the data were coded, and similar foci were categorised and subcategorised. This process led to the identification of themes. Both triangulation of the data (member checks, field note comparison, observer reflection and verification of the data) and assuring the data's trustworthiness (credibility, dependability and confirmability) were undertaken. Results: Fourteen focus group discussions were held countrywide. Three themes emerged from the data. A macro theme included all governance issues, a meso theme included all structural issues and a micro theme included all aspects related to clinical experience. Conclusion: The complex nature of clinical physiotherapy education and its diversity can be seen in these emerging themes. All the categories and subcategories making up these themes must now be considered in the next step of developing this tool. Clinical implications: Quality assurance and minimal training standards may be ensured.

Research from Low-Income and Middle-Income Countries will Benefit Global Health and the Physiotherapy Profession, but it Requires Support.

Disparities in research publications are common in the physiotherapy and rehabilitation fields.1 A small proportion of published research arises from low-income and middle-income countries (LMICs),1,2 home to 85% of the world's population. Systems-level, institutional-level, and individual-level factors contribute to these disparities. With urgent and unified actions, global health and the standard of physiotherapy research in LMICs can be improved and strengthened. In this editorial, we will discuss the challenges encountered by researchers from LMICs in conducting and publishing high-quality research and propose potential strategies to address these challenges.

Factors affecting social integration after road traffic orthopaedic injuries in Rwanda.

Background: Road traffic injuries (RTIs) leading to long-term disability present a significant public health challenge, causing immense personal and societal consequences. Every year, 50 million people are hurt, 1.2 million die, 30% are permanently disabled, and 14% cannot return to work due to road traffic accidents. However, in many developing countries, information on the social integration of patients post-RTI remains limited. This study aimed to identify factors contributing to social integration following road traffic-related orthopedic injuries (RTOI) in Rwanda. Methodology: A multicenter, cross-sectional study included 369 adult Road traffic orthopedic injuries (RTOI) victims from five Rwandan referral hospitals. Participants completed the IMPACT-S Questionnaire between 2 June 2022, and 31 August 2022, two years after the injury. It measured social integration in terms of activities and paricipation. We used logistic regression statistical analysis with a significance level of p < 0.05 to estimate odds ratios (OR) and 95% confidence intervals (CI). The Institutional Review Board for Health Sciences and Medicine at the University of Rwanda College of Medicine ethically authorized this study. Participants signed a written consent form before participating in the study. The data was kept private and was used only for this study. Results: The study's findings indicated that the mean age of RTOI victims was 37.5 ± 11.26 years, with a notable male predominance over females. Of the participants, 5.69% were unable to resume normal life activities. The overall mean score on the IMPACT-S scale was moderate, at 77 ± 17. Specifically, participants achieved an average score of 76 ± 16 for "activities" and a higher average of 84 ± 16 for "participation." Certain factors were associated with poor social integration compared to others, including belonging to the age group above 65 years (OR = 8.25, p = 0.02), female sex (OR = 3.26, p = 0.02), lack of rehabilitation (OR = 3.82, p = 0.01), and length of hospital stay >15 days (OR = 4.44, p = 0.02). Conclusion: The majority of RTOI victims in Rwanda achieved successful reintegration into society; nevertheless, their mobility and community engagement were more significantly impacted compared to other aspects assessed by the IMPACT-S scale. The study emphasized the importance of early management, effective rehabilitation, and prompt patient discharge from the hospital in facilitating a successful return to everyday life after road traffic-related orthopedic injuries.

A tool to evaluate physiotherapy clinical education in South Africa.

Background: Physiotherapy clinical education is complex. The dynamic learning milieu is fluid and multidimensional, which contributes to the complexity of the clinical learning experience. Consequently, there are numerous factors which impact the clinical learning experience which cannot be measured objectively - a gap which led to the development of our study. Objectives: To develop, validate, and test the reliability of an assessment tool that evaluates the effectiveness and quality of physiotherapy clinical education programmes. Method: A mixed methods approach in three phases included physiotherapy academics, clinical educators, and clinicians throughout South Africa. Phase One was a qualitative study: focus group discussions determined items and domains of the tool. Phase Two established the content and construct validity of the tool, a scoring system and a name for the tool, using the Delphi method. In Phase Three, factor analysis reduced the number of items, and the feasibility and utility of the tool was determined cross-sectionally. Results: The Vaneshveri Naidoo Clinical Programme Evaluation Tool (VN-CPET) of 58 items and six domains was developed and found to be valid, reliable (α = 0.75) and useful. The six domains of VN-CPET include governance; academic processes; learning exposure; clinical orientation; clinical supervision and quality assurance and monitoring and evaluation. Conclusion: The Vaneshveri Naidoo Clinical Programme Evaluation Tool is a valid, reliable and standardised tool, that evaluates the quality and effectiveness of physiotherapy clinical education programmes. Clinical implications: This tool can objectively evaluate the quality and effectiveness of physiotherapy clinical education programmes in South Africa, and other health science education programmes, both locally and globally, with minor modification.

Community reintegration post-stroke in New Zealand: understanding the experiences of stroke survivors in the lower South Island.

PURPOSE: Optimal community reintegration is a key rehabilitation outcome post-stroke. This concept has been investigated in many countries but not qualitatively in New Zealand. We explored perceptions about community reintegration of stroke survivors living in southern New Zealand. METHOD: Qualitative interviews were used to collect data. Recruitment was via local stroke clubs, inviting adult stroke survivors (stroke duration > six months, any severity or type) living in the lower South Island. Data were analysed using the General Inductive Approach. RESULTS: Eight stroke survivors (two female, six males; age range 50-80 years, mean 66 years (SD = 12); mean time since stroke 6.5 (SD = 4) years) participated. Participants' perceptions of what is integral to reintegration into their community were shaped by four themes, namely: (1) personal relationships, (2) re-establishing normality (old and new), (3) purpose in life, and (4) independence. CONCLUSIONS: Stroke survivors in New Zealand hold many similar perceptions about optimal community reintegration with those living elsewhere. Key to successful community reintegration, irrespective of geography, culture and ethnicity, appears to be involvement in meaningful activities, and reduced reliance on others whilst maintaining or developing good social relationships. These fundamental components are then contextually nuanced by what is meaningful and important to the individual.IMPLICATIONS FOR REHABILITATIONOptimal community reintegration post-stroke is arguably the key goal of rehabilitation, and thus should be enabled and measured.To optimise community reintegration post-stroke, rehabilitation should focus on enabling stroke survivors' social relationships, independent community mobility, and engagement in meaningful activities.Optimal community reintegration post-stroke is however contextual. Rehabilitation professionals must understand what each patient considers successful community reintegration to be for them and tailor their rehabilitation accordingly.

Ability of Physiotherapists and Physiotherapy Students to Evaluate and Classify Lumbar Movement Control Using Lumbopelvic Movement Control Tests.

Purpose: The aims of our study were to (1) describe the tests that physiotherapists use to assess lumbopelvic movement control and (2) compare physiotherapists' and physiotherapy students' ability to evaluate lumbar movement dysfunction in patients with non-specific low back pain (NSLBP). Method: A quantitative, observational, cross-sectional study design was used. A total of 93 qualified physiotherapists and 96 students participated in our study. The physiotherapists reported whether they were familiar with lumbopelvic movement control tests and indicated which tests they used to assess lumbopelvic movement control (Part 1). Both the physiotherapists and the students evaluated and classified lumbopelvic movement control while observing videos of patients with NSLBP (Part 2). The responses from physiotherapists and students were described and compared between the two groups using the Fisher exact test (p ≤ 0.05). Odds ratios were calculated in terms of years of experience and level of education. Results: A total of 80 physiotherapists (86%) were familiar with lumbopelvic movement control tests, but only a few were using those tests as part of the assessment of patients; 12 (13%) used waiter's bow; 16 (17%) used rocking forward; 17 (18%) used rocking backward; 32 (34%) used sitting knee extension; 34 (37%) used prone knee flexion; and 70 (75%) used posterior pelvic tilt. The physiotherapy students and qualified physiotherapists generally agreed on the ratings of most of the videos (e.g., as correct or incorrect). A difference was found in only 3 of 24 videos for both the qualified physiotherapists and the physiotherapy students (p = 0.001, p = 0.007, and p = 0.033, respectively), which indicates that qualified physiotherapists and students agreed and classified 21 videos the same. No differences were found in the ability of physiotherapists (regardless of experience) or students to classify patients as presenting with either a flexion or an extension pattern. Conclusions: The majority of physiotherapists were familiar with lumbopelvic movement control tests, but only a few used them. Both the physiotherapists and the students were able to classify patients with NSLBP presenting with either a flexion or an extension pattern.

Objectif : 1) décrire les tests qu'utilisent les physiothérapeutes pour évaluer le contrôle des mouvements lombo-pelviens et 2) comparer la capacité des physiothérapeutes et celle des étudiants en physiothérapie à évaluer la dysfonction des mouvements lombaires chez les patients ayant des douleurs lombaires non spécifiques (DLNS). Méthodologie : étude d'observation transversale quantitative auprès de 93 physiothérapeutes qualifiés et de 96 étudiants. Les physiothérapeutes ont indiqué s'ils connaissaient les tests de contrôle des mouvements lombo-pelviens et quels tests ils utilisaient pour évaluer ces mouvements (partie un). Tant les physiothérapeutes que les étudiants ont évalué et classé le contrôle des mouvements lombo-pelviens à partir de vidéos de patients ayant des DLNS (partie deux). Les chercheurs ont décrit et comparé les réponses des physiothérapeutes et des étudiants au moyen du test exact de Fisher (p ≤ 0,05). Ils ont calculé les rapports de cote d'après les années d'expérience et le niveau d'instruction. Résultats : au total, 80 physiothérapeutes (86 %) connaissaient les tests de contrôle des mouvements lombo-pelviens, mais seuls quelques-uns les utilisaient dans leur évaluation des patients. Ainsi, 12 (13 %) utilisaient la courbette du serveur; 16 (17 %), le balancement vers l'avant; 17 (18 %), le balancement vers l'arrière; 32 (34 %), l'extension du genou en position assise; 34 (37 %), la flexion du genou en position couchée; et 70 (75 %), la bascule postérieure du bassin. Les étudiants en physiothérapie et les physiothérapeutes qualifiés s'entendaient généralement sur la classification de la plupart des vidéos (correct ou incorrect). Ils sont parvenus à des résultats différents à l'égard de seulement trois des 24 vidéos (p = 0,001, p = 0,007 and p = 0,033, respectivement). Ainsi, les physiothérapeutes et les étudiants ont classé 21 vidéos de la même façon. Les physiothérapeutes (quelle que soit leur expérience) et les étudiants n'ont pas démontré de différence quant à leur capacité de classer les patients qui présentaient un profil de flexion ou d'extension. Conclusion : la majorité des physiothérapeutes connaissait les tests de contrôle des mouvements lombo-pelviens, mais seuls quelques-uns les utilisaient. Tant les physiothérapeutes que les étudiants étaient en mesure de classer les patients ayant des DLNS dans un profil de flexion ou d'extension.